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Home My WebLink About20170191.tiffRESOLUTION RE: APPROVE GRANT CLOSEOUT FOR VARIOUS WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA) PROGRAMS AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with a Grant Closeout for Various Workforce Innovation and Opportunity Act (WIOA) Programs between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, Employment Services of Weld County, and the Colorado Department of Labor and Employment, for all programs that have Expenditure Authorizations ending during the period of July 1, 2015, and June 30, 2016, with further terms and conditions being as stated in said grant closeout, and WHEREAS, after review, the Board deems it advisable to approve said grant closeout, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Grant Closeout for Various Workforce Innovation and Opportunity Act (WIOA) between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, Employment Services of Weld County, and the Colorado Department of Labor and Employment, be and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said grant closeout. cc HSO(cm/SP)/Sc) ctc-rC pc) of/aco/I"7 2017-0191 HR0088 RE: GRANT CLOSEOUT FOR VARIOUS WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA) PROGRAMS PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 16th day of January, A.D., 2017. ATTEST:d J ;gi Weld County Clerk to the Board BY: BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLO DO ( 7-Y)n-61 Julie A. Cozad, Chair Steve Moreno, Pro-Tem puty Clerk to the Board EXCUSED Sean P. Conway AP ttorney arbara Kirkmeyer Date of signature: O t / 9 -1 / l 2017-0191 HR0088 CApd.)-Nd [Dr MEMORANDUM December 7, 2016 'TO: Board of County Commissioners — Pass -Around FR: Judy A. Griego, Director, Human Services RE: Department of Human Services' 2015-2016 Workforce Innovation and Opportunity Act (WIOA) Grant Closeout for the Colorado Department of Labor and Employment (CI)LE) Please review and indicate if you would like a work session prior to placing this item on the Board's agenda. Request Board Approval of the Departments' 2015-2016 Workforce Innovation and Opportunity Art (WIOA) Grant Closeout for the Colorado Department of Labor and Employment (CDLE). The closeout packet is required by the Year -End Contract Closeout Procedures of the Colorado Department of Labor and in accordance with their Policy Guidance Letter # 06-12-F] for all programs that have Expenditure Authorizations ending during the period of July i , 2015 to June 30, 2016. The county was instructed to follow the last year's close out procedures even though CLEAR is now the reporting format and not the VAX system. Revenues and expenses are reconciled based on the CLEAR Budget Availability Report, our internal spreadsheet, and the CLEAR billings. The grant obligations are released for those projects that are fully expended by the Division of Employment Services. I do not recommend a Work Session. I recommend approval of this Closeout. Sean Conway Steve Moreno Barbara Kirkmeyer Mike Freeman Julie Cozad Approve Request BOCC Agenda Work Session 1-- 2017-0191 Pass -Around Memorandum; December 7, 2016 - ID 905 Page 1 Attachment K Colorado Department of Labor and Employment Grant Closeout Signature Page Workforce Region: Employee Services of Weld County Address: P.O. Box 1805 Greeley, CO 80632 Director: Tami Grant Phone Number: 970-400-6754 Fiscal Manager: Leonard Bottorff Phone Number:970-400-6537 Master Grant/Contract Agreement Number: CMS# 54599 CLOSEOUT SUMMARY This closeout packet signature page includes the following contracts: Program Year Funding Stream Amount Vax # Line Item FSC123# FY 14 TAA Case Management $ 14,422.00 17C400000 FY 15 TAA Case Management $ 948.74 17C500000 FY 15 DVOP $ 8,000.00 203500000 FY 16 DVOP $ 5,249.97 203600000 PY 14 Wagner Peyser $ 216,631.68 205400000 PY 15 Wagner Peyser $ 258,792.75 205500000 PY 14 Wagner Peyser MSFW $ 27,933.00 2M5400000 PY 14 10% Summer Job Hunt $ 17,621.92 2S5400000 PY 15 10% Summer Job Hunt $ 19,550.35 2S5500000 PY 11 HIB $ 53,735.00 2155 1NH02/436100000 PY 14 Disaster NEG $ 78,319.00 2414 3PK02/442300000 PY 14 WIOA Adult Administration $ 49,919.00 46A400000 FY 16 WIOA Adult Administration $ 17,121.27 46A500000 PY 14 DW Administration $ 23,607.00 46D400000 FY 16 DW Administration $ 12,517.83 46D500000 FY16 Adult $ 349,984.14 48A500000 PY 14 DW Local $ 212,461.00 48D400000 FY 16 Dislocated Worker $ 94,392.56 48D500000 PY15 Adult Administration $3,972.00 4A6500000 PY 15 WIOA Adult $ 35,748.00 4A8500000 FY14 DW Admin transferred to Adult $ 23,607.00 4BD400000 FY 16 DW Admin transferred to Adult $ 3,317.00 4BD500000 PY 15 WIOA DW Admin $ 3,317.00 4D6500000 PY 15 WIOA 25% Enhanced DW Admin $ 2,195.00 4D7500000 PY 15 WIOA DW $ 29,853.00 4D8500000 PY 15 WIOA 25% Enhanced DW $18,462.51 4D9500000 PY 15 WIOA DW $ 29,853.00 4DN500000 FY 16 25% Enhanced DW Administration $ 5,122.00 4ED500000 FY 14 25% Enhanced DW $ 48,785.00 4KD300000 PY 14 3.75% Performance Incentive $ 16,971.00 4LD400000 PY 14 Dislocated Worker Trx Adult $ 212,461.00 4ND400000 FY 15 25% Enh DW Hire CO Admin $ 12,655.09 4OD400000 FY 15 25% Enh DW Hire CO $ 114,897.48 4PD400000 FY 15 SP NEG Planning $ 25,239.17 4S3500000 FY 15 SP NEG Administration $ 22,782.00 4S4500000 FY 15 SP NEG Program $ 180,601.10 4S5500000 FY 15 25% TAA Case Mgmt. $20,000.00 4TD400000 PY 14 Youth Administration $50431.10 4Y6400000 PY 14 Youth Out of School $435,427.00 4Y7400000 PY 15 Youth Out of School $ 367,447.43 4Y7500000 PY 14 Youth In School $ 186,611.00 4Y8400000 PY 15 Youth In School $ 59,077.82 4Y8500000 PY 14 Youth Incetives $1000.00 4YW400000 Total $3,371,039.91 Each Program Year (PY) and funding stream listed above will have the following forms completed: Form Attachment I and Attachment II: • Grant Recipient's Release (Attachment I: page 1 of 6) • Contract Closeout Tax Certification (Attachment I: page 2 of 6) • Schedule of Unclaimed Checks (Attachment 1: page 3 of 6) • Grant Recipient's Assignment of Refunds, Rebates, and Credits (Attachment C page 4 of 6) • Subrecipient Certification of Physical Inventory (Attachment I: page 5 of 6) • Physical Inventory List (Attachment I: page 6 of 6) • Grant Closeout Reconciliation Worksheet (Attachment H) I certify to the best of my knowledge and belief the following financial data reported in this closeout packet is correctly stated. By:Julie A. Cozad, Chaitr Local Elected Official ' Date JAN 16 2017: Chair, Board of County Co missioners or Authorized Signature oZo/7 0/91 Attachment E Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT EMPLOYMENT AND TRAINING PROGRAMS PROGRAM INCOME EXPENSE REPORT FROM (PIERF) SUBRECIPIENT: Employment Services of Weld County Calendar Qrtr End Date: 06/30/16 CDLE PIER VAX#: NA 1. CUMULATIVE PROGRAM INCOME CASH REPORTED ON CASH REQUEST THRU QUARTER END DATE: NET (Undisbursed) LINE ITEM 2. BUDGET ALLOCATION: COST CATEGORY/BUDGET LINE ITEM(S)-FCSI23# on Expense Reporl VAX# FCS#: VAX# FCS#: 0.00 VAV EXP REPORT NUMBER Total Program Income FCS123 AMOUNT NONE Disbursed Prog Income Net (Undisbursed) (Expended) Program Income NONE 0.00 VAX# FCS#: VAX# FCS#: 0.00 VA X# FCS#: 0.00 0.00 VAX# FCS#: Total (total net must equal amount on Pa 0.00 CERTIFICATION: 0.00 0.00 0.00 I certify to the best of my knowledge and belief the above reported information is accurate and complete for t)}e period re orted. Board Fized Signature Julie A. Cozad, Chair, Weld County Commissioners See instructions for completing this form on the next page. of JAN 1 6 2017 Date 07o/7-} O9/ Revised: 6/1/01 Attach E-Prog Inc Exp 2016.xlsx Attachment E Page 2 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT EMPLOYMENT AND TRAINING PROGRAMS PROGRAM INCOME EXPENSE REPORT FORM (PIERF) Instructions for Completing the Program Income Expense Report Form (PIERF): Subrecipient: Enter the subrecipient's name that generated the program income. Calendar Quarter End Date: Enter the quarter end date in which the program income was generated. CDLE Assigned VAX PIER #: After the initial reporting of generated program income using the PIER, CDLE will create a VAX # for the Program Income Expense Report Form (VPIERF). Enter the number of the VAX PIFRF ifknnwn 1. Cash Request Line Item - FCS123 Column: Enter the cash request FCSI23 coding from the line item of the VAX Cash Request Form (VCRF) that the net generated program income was reported. Cash Request Line Item - Amount Column: Enter the net generated program income amount that was reported on the VCRF. 2. Program Income Allocation - Cost Category(ies)/Budget Line Item(s): Enter the cost categories/budget line items that the amount reported on the Program Income Line Item will be allocated Program Income Allocation - Income Amount: Enter the Income Budgeted amount for the expenditure of each cost category(ies)/budget line item(s) for the reporting quarter. Program Income Allocation - Disbursed Income Expense: Enter the amount expended against the cost categorv(ies)/budget line item(s) through the reported calendar quarter end date. Total Net Program Income: Total program Income Amount and Income Disbursed/Expense columns. The Total Net Program Income is program income earned but not expended. The Amounts should equal the amount recorded in the Cash Request Line Item Amount. Authorized Signature and Date: Original form submitted to CDLE must be signed and dated by authorized signatory. Revised: 6/1/01 Attach E-Prog Inc Exp 20 16.xlsx Attachment F Page 1 of 3 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT EMPLOYMENT AND TRAINING PROGRAMS STAND-IN COST REPORT FORM (SICRF) AND LEVERAGED RESOURCES REPORT FORM Subrecipient Emp Svcs of Weld County Name: GRANTS Program Year of Funds COST CATEGORY(IES /BUDGET LINE ITEM(S) Stand -In Administration Stand -In Program Leveraged Cash Match Leveraged Other Federal In -Kind unds Expender Total GRANT NAME: WIA Adult PY or FY Current Prior Year Before Prior PY15 1,145.00 18,027.00 19,172.00 PY14 1,064.00 16,754.00 17,818.00 PY13 982.00 15,466.00 16,448.00 GRANT NAME: WIA Dislocated Workers PY or FY Current Prior Year Before Prior PY15 2,837.00 16,022.00 18,859.00 PY14 862.00 13,578.00 14,440.00 PYI3 706.00 11,108.00 11,814.00 GRANT NAME: WIA Youth PY or FY Current Prior Year Before Prior PY15 1,298.00 22,707.00 24,005.00 PY14 1,156.00 20,457.00 21,613.00 PYI3 1,299.00 18,207.00 19,506.00 GRANT NAME: WIA 10%StatewideActy. PY or FY Current Prior Year Before Prior PY 15 oosOTENTER 0.00 PY 14 DO NOT ENTER 0.00 PY13 DO NOT ESTER 0.00 GRANT NAME: WIA 25% Enh. DW PY or FY Current Prior Year Before Prior PY 15 0.00 0.00 0.00 PY14 98.00 1,543.00 1,641.00 PY13 80.00 1,263.00 1,343.00 GRANT NAME: FED EUC PY or FY Current Prior Year Before Prior PY15 DONorEN ER 0.00 0.00 PY14 DO NO7'iiTER 0.00 0.00 PYI3 onstallta 0.00 0.00 GRANT NAME: WIA NEC PY or FY Current Prior Year Before Prior PY 15 0.00 0.00 0.00 PY14 64.00 1,012.00 1,076.00 PY13 174.00 2,735.00 2,909.00 GRANT NAME: WP 10% MSbW PY or FY Current Prior Year Before Prior PY15 DO NOT 0.00 0.00 PY14 IdOlOTENTD 1,965.00 1,965.00 PYI3 oo,orsetR 1,012.00 1,012.00 Stand In/Leveraged Costs from 7/1/15 to 6/30/16 CDLE Assigned VAX SICRF #: 54599 CERTIFICATION: I certify to thgbest of m Authorized Signature Julie A. Cozad, Ch'a'ir Board of Weld County Commissioners ledge and belief the above reported information is accurate and complete of the period reported. JAN 16 2017 Date Revised: 2/28/10 O7O/7- 2/9( Attach F-SICR2016.xtsx Attachment F Page 2 of 3 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT EMPLOYMENT AND TRAINING PROGRAMS STAND-IN COST REPORT FORM (SICRF) AND LEVERAGED RESOURCES REPORT FORM Subrecipient Emp Svcs of Weld County Stand In/Leveraged Costs from 7/1/14 to 6/30/15 DLE Assigned VAX SICR #: 54599 GRANTS I Program/ COST CATEGORY(IES /BUDGET LINE ITEM(S) fiscal Yea of Funds Stand -In dministratior Stand_in Program Leveraged Cash Match Leveraged In -Kind Other Federa7r unds Expend el Total GRANT NAME: H -I B Tech Skills Training PY or FY Current Prior Year Before Prior PY15 0.00 0.00 0.00 PY14 24.00 373.00 397.00 PY13 5.00 82.00 87.00 GRANT NAME: Wagner Peyser PY or FY Current Prior Year Before Prior PY15 DO NOT ENTER 0.00 0.00 PY14 DONOT ENTER 38,123.00 38,123.00 PY13 DO NOT ENTER 26,492.00 26,492.00 GRAN I NAME: WP 10% SJH PY or FY Current Prior Year Before Prior PY15 NOWT ENTER 0.00 0.00 PY14 DONOYENTER 2,003.00 2,003.00 PY13 DONOfENTER 3,005.00 3,005.00 GRANT NAME: Vets DVOP OONNIENTER 0.00 DO NOT ENTER 0.00 DO NOT ENTER 0.00 GRANT NAME: Vets LVER OONOTENTER 0.00 OONQT ENTER:': 0.00 OO rIOT ENTEa 0.00 GRANT NAME: U/Reemployme DQNOTENTER 0.00 IX}NOTENTER?i 0.00 DO NOT ENT0 0.00 GRANT NAME: WP-ESF PY or FY Current Prior Year Before Prior PY15 00N0T ENTRR;! 0.00 0.00 PY14 ➢0N0T ENTER }; 11,549.00 11,549.00 PY 13 DO NOT ENTER' 20,531.00 20,531.00 CERTIFICATION: I certify tythe best of y knowledge and belief the above reported information is accurate and complete of the ut orized Sig atur Julie A. Cozad, C air, Board of Weld County Commissioners See instructions for completing this form on the next page. JAN 162017 Date Revised: /28/10 do/ 7-_ ©!9/ Attach F-SICR2016.xlsx Attachment F Page 3 of 3 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT EMPLOYMENT AND TRAINING PROGRAMS STAND-IN COST REPORT FORM (SICRF) Instructions for Completing the Stand -In Cost Report Form (SIRE): Subrecipient: Enter the subrecipient's name that incurred stand-in costs. Costs incurred During Program Year Ended: Enter the Program/Fiscal Year in which the Stand -In and Leveraged costs were incurred dur this period. CDLE Assigned VAX SICRF #: Atter the initial reporting of incurred stand-in costs using the VAX SICRF, CDLE will create a VAX Stand -In Cost Report Form (VSICRF). Enter the VAX number of the VSICRF, if known. Cost Category(ies)/Budget Line Item(s): Other: If stand-in costs were incurred against cost categories/budget line items other than Administration and Program, enter the cost category/budget line item. Program Year of Funds: For each applicable grant funding year that incurred stand-in/leveraged costs, enter the applicable program/fiscal year of funds. For example, during Program Year 2011, a subrecipient could have incurred stand-in costs which benefitted its PY2011 program (current year of funds), or PY2010 program (prior year of funds), or PY2009 program (year of funds before prior year). As such, "PY 1 1" would be entered on the Current year line, "PY I 0" would be entered on the Prior Year line, and "PY09" would be entered on the Year Ft -fore Prior Year line In addition indicate either PV or FV of filmic whichever henefitted or annlieahle Grant Name: For each grant name, report the Stand-in costs or Leveraged/Match funds incurred, by cost category/budget line item, against the current, prior, and year before the prior program/fiscal year's of funds, during the program year ended period. If stand-in costs benefitted a grant(s) other than those listed on page 1 and page 2, provide the grant name(s) on page 2 at the end of the chart. Authorized Signature and Date: Original form submitted to CDLE must be signed and dated by authorized signatory. Revised: 2/28/10 Attach F-sICR20I6.xlsx Attachment I Page 1 of 6 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT RECIPIENTS RELEASE Grant Recipient's Name: Employment Services of Weld County Address: PO Box 1805, Greeley, CO 80632 Release Date: 9/20/16 Pursuant to the terms of Contract/Grant Agreement Number CMS# 54599 , including the Expenditure Authorizations (EAs) awarded under said Contract/Grant Agreement, as VAX/FCS123 number(s): 17C4000000 17C5000000 , 2035000000 , 2036000000 , 2054000000 , 2055000000 2M54000000 , 2554000000 2555000000 2155/1NH02 , 2414/3PK02 , 46A4000000 46A5000000 , 4604000000 , 4605000000 48A5000000 , 48O4000000 , 48O5000000 , 4A65000000 , 4A85000000 , 4B04000000 , 4805000000 4O65000000 , 4075000000 , 4O85000000 , 4095000000 , 4DN5000000 , 4ED5000000 , 4KD3000000 4LD4000000 , 4ND4000000 , 4004000000 , 4PD4000000 , 4S35000000 , 4S45000000 , 4S55000000 4TD4000000 , 4Y64000000 , 4Y74000000 , 4Y75000000 , 4Y84000000 , 4Y85000000 , 4YW4000000 and in consideration of the sum of Total amount paid of $3,371,039.91 and payable of ($ of Unclaimed Checks Total) under the said Contract to (Contractor's Name and Address) hereafter called the Grant Recipient or to its assignees, if any, the Grant Recipient, upon payment of the said sum by the COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT, hereinafter called CDLE, does remise, release, and discharge CDLE, its officers, agents, and employees, of and from all liabilities, obligations, claims, and demands whatsoever under or arising from said Contract/Grant Agreement except: 1. Specified claims in stated amounts or in estimated amounts where the amounts are not susceptible of exact statement by the Grant Recipient, as follows( if none, so state): NONE VAX/ FCS123 Number Invoice Date (If Known) Vendor Invoice or P.O. # Line Item Cost Category Amount Expected Payment Amount NONE 2. Claims, together with reasonable expenses incidental thereto, based upon the liabilities of the Grant Recipient to third parties arising out of the performance of the said contract, which are not known to the Grant Recipient on the date of the execution of this release and of which the Grant Recipient gives notice in writing to the CDLE within the period specified in the said Contract/Grant Agreement. 3. Claims after closeout, for costs which results from the liability to pay Unemployment Insurance costs under a reimbursement system or to settle Worker's Compensation claims. This release has been executed this 16th day of January, 2017. Authorized Signa Julie A. Cozad U JAN 1 6 2017 Title Chair, Weld County Board of Commissioners 02-0/ 7-0/57 Attach I-1 Gran RecRelForm2016.xisx Attachment I Page 2 of 6 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT CONTRACT CLOSEOUT TAX CERTIFICATION In the performance of Contract/Grant Agreement Number CMS# 54599 , including the Expenditure Authorizations (EAs) awarded under said Contract/Grant Agreement, identified as VAX/FCS123 number(s) : 17D4000000 , 2034000000 , 2035000000 2054000000 , 2S54000000 , 2W25000000 , 2W26000000 , 3213000000 4361000000 , 4423000000 , 46A4000000 , 4742000000 , 4822000000 48D4000000 , 4A65000000 , 4A85000000 , 4BD4000000 , 4D63000000 4D65000000 , 4D75000000 , 4D83000000 , 4D85000000 , 4DN5000000 4ED4000000 , 4ED5000000 , 4FD4000000 , 4KD3000000 , 4LD4000000 4ND4000000 , 4OD4000000 , 4S45000000 , 4TD4000000 , 4Y63000000 4Y64000000 , 4Y73000000 , 4Y74000000 , 4Y84000000 , 4YW4000000 I certify that I have complied with requirements of the law and the Colorado Department of Labor and Employment, regarding the obtaining of employer identification/account numbers; collection, payment, deposit, and reporting of federal, state, and local taxes; and the provision of W-2 forms to employees/enrollees who are not now my employees. For present employees/enrollees (formerly employed under the contract), W-2 forms will be furnished as specified in Circular E. Employer's Tax Guide. Grant Recipient Name: Employment Services of Weld County Grant Recipient Address: PO Box 1805 Greeley, CO 80632 Grant Recipient Employer: Weld County Dept of Human Services Employer's Identification Number: 84-6000813 This certification has been executed this 16th day of January, 2017. Authorize Sign JAN 18 2017 Julie A. Cozad Title Chair, Weld Count Board .fjVsmmissioners 020/7-o/9i Attach I-2ContractcIoseoutTaxCert2016.xlsx Attachment I Page 3 of 6 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT SCHEDULE OF UNCLAIMED CHECKS Grant Recipient Name: Employment Services of Weld County Contract/Grant Agreement Number: CMS#54599 Release Date: VAX/FSC123 Number Check Number Payee Check Amount Payee's Last Known Address NONE Total Amount Unclaimed This schedule has been executed this 16th day of January, 2017. By Authorized Sign Julie A. Cozad a JAN 16 Title Chair, Weld County Board of Commissioners 2017, O20/7 -O/* Attach 1-3 ScheduleofUnclaimedChecks 2016.xlsx Attachment I Page 4 of 6 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT RECIPIENT'S ASSIGNMENT OF REFUNDS, REBATES, AND CREDITS Grant Recipient's Name: Emp Svcs of Weld County Street Address: PO Box 1805 City and State: Greeley, CO 80632 Contract/Grant Agreement No: CMS# 54599 Pursuant to the terms of Contract/Grant Agreement Number CMS# 54599 , including the Expenditure Authorizations (EAs) awarded under said Contract/Grant Agreement, identified as 17C4000000 , 17C5000000 , 2035000000 VAX/FCS123 number(s) : 2036000000 , 2054000000 , 2055000000 2M54000000 , 2S54000000 2S55000000 , 2155/1NH02 , 2414/3PK02 46A4000000 , 46A5000000 46D4000000 , 46D5000000 , 48A5000000 , 48D4000000 , 48D5000000 4A65000000 , 4A85000000 , 4BD4000000 , 4BD5000000 , 4D65000000 4D75000000 , 4D85000000 , 4D95000000 4DN5000000 , 4ED5000000 4KD3000000 , 4LD4000000 , 4ND4000000 , 4OD4000000 , 4PD4000000 4S35000000 , 4S45000000 , 4S55000000 , 4TD4000000 , 4Y64000000 4Y74000000 , 4Y75000000 , 4Y84000000 , 4Y85000000 , 4YW4000000 and in consideration of the reimbursement of costs and payment of fee, as provided in the said Contract/Grant Agreement and any assignment thereunder, the Grant Recipient's Name and Address (hereinafter called the Grant Recipient) does hereby: 1. Assign, transfer, set over and release to the Colorado Department of Labor and Employment (hereinafter called CDLE), all right, title and interest to all refunds, rebates credits or other amounts (including any interest thereon) arising out of the performance of the said contract/grant agreement, together with all the rights of action accrued on which may hereafter accrue thereunder. 2. Agree to take whatever action may be necessary to effect prompt collection of as such refunds, rebates, credits or other amounts (including any interest thereon due or which may become due, and to forward promptly to CDLE. 3. Agree to cooperate fully with CDLE as to any claim or suit in connection with such refunds, rebates, credits or other amounts due (including an interest thereon): execute any protest, pleading, application, power of attorney or other papers in connection therewith; and to permit CDLE to represent it at an hearing, trial or other proceeding arising out of such claim or suit. This assignment has been executed this 16th day of January, 2017. u orized ` • nre Title mivision Head of Employment Services Attach I-4RefRebCredits2016.xPsx Attachment I Page 5of6 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT SUBRECIPIENT CERTIFICATION OF PHYSICAL INVENTORY Subrecipient Name: Emp Svcs of Weld County Contact Person: Michelle Boihuis Address: PO Box 1805 Phone Number: 970-352-1551 ext 6532 Greeley, CO 80632 I hereby certify that all property/equipment previously purchased with or transferred from the Comprehensive Employment and Training Act (CETA) or the Job Training Partnership Act (JTPA) program to the Workforce Investment Act (WIA) programs or purchased under any Colorado Department of Labor and Employment (CDLE) federally funded grant or transferred with the CDLE's approval is included in the attached listing for the above -noted subrecipient. The attached listing has been verified by a physical inventory. Changes/revisions are: LL Noted H Not Applicable I certify that this property is being used for purposes that it was originally purchased for and will be repaired or replaced by my insurance if damaged, lost, or stolen. I certify that all property/equipment previously purchased with or transferred from the CETA or the JTPA programs to WIA program or purchased under a CDLE federally funded grant or transferred with the CDLE's approval with a fair market value (FMV), established by our existing local procedures, of $5,000 or more, has been identified. I further certify that the proceeds of all property/equipment previously purchased with or transferred from the CETA or JTPA program to the WIA program, with a FMV of $5,000 or more, will be returned to CDLE, in order to return the proceeds to the U.S. Department of Labor. Subrecipient Direc or's S;fgrJ'ature JAN 1 6 2017 Date Julie A. Cozad, Chair Board of Weld County Commissioners OZa/ 7.- o/9/ Revised: 6/1/06 Attach I-5CertofPhysInv2016.xlsx Attachment I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT 0 cn PHYSICAL INVENTORY LIST ment Services of Weld Coun O Grant Recipient Name: Em CMS# 54599 Contract/Grant Agreement Number: Release Date: Property Condition Property Location SERIAL # if applicable Program Funding Sources Property Costs Description of Property W Z O z Total Amount Purchase Date VAX/FSC123 Number a) a a E O O 03 03 a) m U O (0 N C O O3 E O c_ N 0 O n N a O t0 N L N 0 a CO a) w -o O c Y >, E -o O -t N o d a d t -C o O a a U O January, 2017. This Physical Inventory List has been e 0 N to •-1 Q Commissioners Title Chair, Weld County Board Attach 1-6 PhyslnvList2016.xlsx Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/20014 YEAR OF FUNDS FY 14 TITLE/PROGRAM/PROJECT TAA Case Managem VAX ERF (VERF) # 17C40000 PROGRAM INCOME START DATE 07/01/14 END DATE 06/30/16 END DATE 06/30/16 I. CASH REQUEST (CR) 17C4 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 7/31/2015 ) 14,422.00 2. Current Program and Admin Cash Needs (CR 4 , Column F) 0.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.=L3.) 14,422.00 IL PROGRAM EXPENSE REPORT (ER) Vax 4 I. Total Expenses + Accruals Previously Reported (Through Last Month) 14,422.00 2. Current Expenses + Accruals (Through End Date of Award) 14,422.00 3. FINAL Program Expenses Contract to Date (II.1.+11.2: 11.3.) ADMINISTRATIVE EXPENSE (ER) Vax 4 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCSI23# 5. Current Expenses + Accruals (Through End Date of Award) 0.00 6. FINAL Administrative Expenses Contract to Date (11.4.+11.5. II.6.) IIL PROGRAM INCOME (PI) EXPENSE REPORT Vax 4 I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (II1.1.+ L I + 111.2.= 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I, FINAL CR Contract to Date (1.3.) 14,422.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 14,422.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES ±/NOL V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.1 - VI.2. = VI.3.) (Refund * Extend ) 0.00 VII. MATCH RECONCILIATION Vax 4 I. FINAL Match Reported Through End of Contract 14,422.00 2. FINAL Expenses Through End of Contract (11.3.+116+111.3.) 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x VII.3.) 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) YES(J /NOLJ The Program Income Expense Report and Cash Request can only be extended through the avalabt6ty o/ the Award and/or Fetleral /undmg penod. Preparer's Signature ( t- kda, 66(.49 Date // Authorized Signatur 2411-17/1�Q�% / //G/1, Date 0110li See instructions for completing this form on the next page. Revised 6/1/06 Attachment H - Grant Closeout- TAA 17c4. xis Attachment H Page I oft COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 10/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 15 TITLE/PROGRAM/PROJECT TAA Case Managem VAX ERF (VERF) it 17C50000 END DATE 06/30/17 END DATE I. CASH REQUEST (CR) 17C5 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 5/31/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 0.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2:1.3.) 0.00 IL PROGRAM EXPENSE REPORT (ER) Vax N I7C5 I. Total Expenses + Accruals Previously Reported (Through Last Month) 948.74 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (II.I +11.2 =11.3.) ADMINISTRATIVE EXPENSE (ER) Vax # ttgg948.74 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 5. Current Expenses +Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (11.4.+11.5: I1.6.) 0.00 III. PROGRAM INCOME (PI) EXPENSE REPORT Vax tt I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1 + 111.2. 111.3.) 0.00 IV RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) 0.00 2. FINAL Expenses Through End of Contract (II.3. + II 6.+111.3.) 948.74 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES LJ/NO LJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED 0.00 I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (Pt Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (II1.3.) 0.00 3. Total PI Cash Balance (VI.1 - VI.2. = V1.3.) (Refund * Extend ) 0.00 VII MATCH RECONCILIATION Vex # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 948.74 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII. I.)> or = to Match Expenditure Requirement(VIL4.)? (Check Box) YESLI /NOLJ The Program Income Expense Report and Cash Request can only be extended through the availability o/ the Award and/or Federal running penon.. Preparer's Signature-7nit telat Date AV&//6 Authorized Signatur 24,4 Date / 0I \9 ) (` See instructions for completing this form on the next page. Revised: 6/1/06 Attachment H - Grant Closeout- TAA 17C5.xls Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 10/01/14 PROGRAM INCOME START DATE YEAR OF FUNDS FY 15 TITLE/PROGRAM/PROJECT DVOP VAX ERF (VERF) # 203500000 END DATE 09/30/15 END DATE L CASH REQUEST (CR) 2035 5,999.99 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/15/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 2,000.01 3. FINAL Program and Admin Cash Needs Contract to Date (I.I +I.2.=1.3.) 8,000.00 II. PROGRAM EXPENSE REPORT (ER) Vax # 17C5 4 6a I. Total Expenses + Accruals Previously Reported (Through Last Month) 8,000.00 2. Current Expenses + Accruals (Through End Date of Award) 8,000.00 3. FINAL Program Expenses Contract to Date (II.I +1I.2. 11.3.) ADMINISTRATIVE EXPENSE (ER) Vax #' 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (II.4.+II.5.=11.6.) 0.00 III. PROGRAM INCOME (PI) EXPENSE REPORT Vax #� I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1 + 111.2: 111.3.) 0.00 IV RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) 8,000.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 8,000.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES WINO H V. CASH REQUEST PROGRAM INCOME CASH REPORTED 1. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = P1 Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend ) 0.00 VII. MATCH RECONCILIATION Pax It }a 9 I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 8,000.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VI1.2 x VII.3.) 0.00 5. Total Match Reported (VII.I.) > or= to Match Expenditure Requirement (V11.4.)? (Check Box) YES Hi /NO IJ ' The Program Income Expense Report and Cash Request can only be extended through the avalabi6ty o/ the Award and/or Federal /undmg penod Preparer's Signature p il/_ll 4_QE 3h`/r` Date /O Authorized Signatur �J // 7 Date /a ( VI) IL See instructions for completing this form on the next page. Revised: 5/1/05 Attachment H - Grant Closeout- DVOP 2035.xts Attachment H Page I of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 10/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 16 TITLE/PROGRAM/PROJECT DVOP VAX ERF (VERF) # 203600000 END DATE 09/30/16 END DATE L CASH REQUEST (CR) 2036 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # ) 2. Current Program and Admin Cash Needs (CR # , Column F) 5,249.97 3. FINAL Program and Admin Cash Needs Contract to Date (I.1.+1.2:1.3.) 5,249.97 IL PROGRAM EXPENSE REPORT (ER) Fax # 2036 I. Total Expenses + Accruals Previously Reported (Through Last Month) 5,249.97 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (II.1.+11.2.=II.3.) 5,249.97 ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (II.4.+II.5=11.6.) 0.00 IIL PROGRAM INCOME (PI) EXPENSE REPORT Fax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ II l.2 = 111.3.) 0.00 IV RECONCILIATION (Cash Request = Expense) L I. FINAL CR Contract to Date (1.3.) 5,249.97 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 5,249.97 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES L/NOU V. CASH REQUEST PROGRAM INCOME CASH REPORTED " x� I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VL RECONCILIATION (P/ Cash Request = P1 Expenses) # I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (III.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend ) 0.00 VIL MATCH RECONCILIATION Vax #I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 5,249.97 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VI1.3.) 0.00 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) YES L' /NOLJ The Program Income Expense Report and Cash Request can only be extended through the availabAdy o/ the Award and/or Federal lundmg penod. Preparer's Signature r7114214-421111440 "' Date /6/11/4 Authorized Signatur /�yJ�7/t, Date ft, ( 14111 See instructions for completing this form on the next page. Revised: 6/1/06 Attachment H - Grant Closeout- DVOP 2036.xls Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/14 PROGRAM INCOME START DATE YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT Wagner Peyser VAX ERF (VERF) # 205400000 END DATE 06/30/16 END DATE L CASH REQUEST (CR) 2054 301,363.32 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 216,631.68 3. FINAL Program and Admin Cash Needs Contract to Date (I.I ++12.-1.3) 517,995.00 IL PROGRAM EXPENSE REPORTER) Vax # 2036 I. Total Expenses + Accruals Previously Reported (Through Last Month) 517,995.00 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (11.1+11.2=11.3.) 517,995.00 ADMINISTRATIVE EXPENSE (ER) Vax 4 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 5. Current Expenses + Accruals (Through End Date of Award) 0.00 6. FINAL Administrative Expenses Contract to Date (II.4.+11.5: II.6.) III PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1:+ 111.2: 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) 517,995.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+III.3.) 517,995.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES J/NOLi V. CASH REQUEST PROGRAM INCOME CASH REPORTED 0.00 I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR 4 , column G) 3. FINAL Program Income Cash Contract to Date (V.I . + V.2 = V.3.) 0.00 VI RECONCILIATION (P/ Cash Request = PI Expenses) rr <c I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (III.3.) 0.00 3. Total PI Cash Balance (VI.I - V1.2. = VI.3.) (Refund * Extend ) 0.00 VIL MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 517,995.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII.I.) > or= to Match Expenditure Requirement (V11.4.)? (Check Box) YESH /NOLJ The Program Income Expense Report and Cash Request can only be extended through the availabdrty or the Award and/or Federal /undmg penotl. Preparer's Signature —7271 I( Date /0/4//G Authorized Signatur �,tiy/�7 Date /)=1) i 114 See instructions for completing this form on the next page. Revised 611/06 Attachment H - Grant Closeout- t/VP 205436.xls Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT Wagner Peyser VAX ERF (VERF) # 205500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) 2055 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 0.00 2. Current Program and Admin Cash Needs (CR # , Column F) 258,792.75 3. FINAL Program and Admin Cash Needs Contract to Date (I.1.+I.2.=1.3.) 258,792.75 IL PROGRAM EXPENSE REPORT (ER) Vax # 2036 I. Total Expenses + Accruals Previously Reported (Through Last Month) 258,792.75 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (11.1.+11.2.=11.3.) 258,792.75 ADMINISTRATIVE EXPENSE (ER) Vax # _ 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCSI23# 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (11.4.+11.5.=l1.6.) 0.00 IIL PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (III.I .+ IIl.2. 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) 258,792.75 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 258,792.75 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES LJ/NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED r I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = V1.3.) (Refund * Extend ) 0.00 VIL MATCH RECONCILIATION Vax # rx:' I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116+111.3.) 258,792.75 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) I.3.) 0.00 5. Total Match Reported (VII. I.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) YES T3 /NOIL • The Program Income Expense Report and Cash Request can only be extended through the availability of the Award and/or Federal tundmg penod Preparer's Signature / 1!I e_121EAS, Date 1694 /14 Authorized Signahu ,j" Date lob Olt See instructions for completing this form on the next page. Revised: 6/1/06 Attachment Ft - Grant Closeout- WP 2055.xls Attachment H Page I of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 06/01/16 PROGRAM INCOME START DATE YEAR OF FUNDS FY 16 TITLE/PROGRAM/PROJECT RESEA VAX ERF (VERF) # 288600000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) 2886 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 0.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+I.2.=1.3.) 0.00 IL PROGRAM EXPENSE REPORT (ER) flax # 2036 i I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (11.1.+11.2.=l1.3.) 0.00 ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) TICS 12.3# 5. Current Expenses + Accruals (Through End Date of Award) 0.00 6. FINAL Administrative Expenses Contract to Date (11.4 +I I.5. II.6.) IIL PROGRAM INCOME (PI) EXPENSE REPORT Vax # .. I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.i-111.2.= III.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (I.3.) 0.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 0.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES H/NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED sa I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = P1 Expenses) �ws44 a_ I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (III.3.) 0.00 3. Total PI Cash Balance (V1.1 - VI.2. = V1.3.) (Refund * Extend ) 0.00 VIL MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 0.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VIL I.) > or= to Match Expenditure Requirement (VII.4.)? (Check Box) YESLJ /NOL deral The Program Income Expense Report and Cash Request can only be extended through the avalaotsry o/ the Award and/or Fetundmg penod Preparer's Signature ��/axiii4 �' Lis Date r/d1/4tP14' Authorized Signatur 272" ;`W Date C 6 l ) _l Il i Sec instructions for completing this form on the next page. Revised: 6/1/06 Attachment H - Grant Closeout- RESEA 2886.xls Attachment H Page I of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT WP MSFW VAX ERF (VERF) # 2M54000000 END DATE 06/30/16 END DATE L CASH REQUEST (CR) 2M54 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 27,933.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+I.2.-1.3.) 27,933.00 II. PROGRAM EXPENSE REPORT (ER) Vax # 2M54s z� x I. Total Expenses + Accruals Previously Reported (Through Last Month) 27,933.00 2. Current Expenses + Accruals (Through End Date of Award) 27,933.00 3. FINAL Program Expenses Contract to Date (11.1.+II.2. 11.3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCSI23# 5. Current Expenses + Accruals (Through End Date of Award) 0.00 6. FINAL Administrative Expenses Contract to Date (II.4.+I1.5. 11.6.) HI. PROGRAM INCOME (PI) EXPENSE REPORT Vax # P. I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ 111.2: 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) 3:S. I. FINAL CR Contract to Date (1.3.) 27,933.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 27,933.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES U/NOL I V. CASH REQUEST PROGRAM INCOME CASH REPORTED 1. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VL RECONCILIATION (P1 Cash Request = PI Expenses) 0.00 I. FINAL Program Income Cash (V.3.) 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = V1.3.) (Refund * Extend ) 0.00 VII. MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + I16.+III.3.) 27,933.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) I.3.) 0.00 5. Total Match Reported (VII.I.) > or = to Match Expenditure Requirement (V II.4.)? (Check Box) YES T3 /NOIJ The Program Income Expense Report and Cash Request can only be extended lhroug Preparer's Signature /a.GGk Date `°4//4 Authorized Signatur / Date /o It 41 die Sec instructions for completing this form on the next page. Revised: 6/1/06 Attachment H - Grant Closeout- WP MSFW 2M54. xls Attachment H Page I of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT 10% SJH VAX ERF (VERF) # 2S54000000 END DATE 06/30/16 END DATE L CASH REQUEST (CR) 2S54 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 17,621.92 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+I.2=1.3.) 17,621.92 H. PROGRAM EXPENSE REPORT (ER) Vax # 2S54§�.. I. Total Expenses + Accruals Previously Reported (Through Last Month) 17,621.92 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (11.1.+11.2.=l1.3.) 17,621.92 ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (I1.4.+II.5.=11.6.) 0.00 HI. PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (II1.1.+ 111.2= 111.3.) 0.00 /V RECONCILIATION (Cash Request = Expense) 1. FINAL CR Contract to Date (I.3.) 17,621.92 2. FINAL Expenses Through End of Contract (11.3. + II 6 +III.3.) 17,621.92 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES Ll/NOLJ V CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VL RECONCILIATION (P/ Cash Request = P/ Lv ense..%) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI. I - VI.2. = V1.3.) (Refund * Extend ) 0.00 VII. MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+III.3.) 17,621.92 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) )(ESL /NOLJ The Program Income Expense Report and Cash Request can only be extended through the availability o/ the Award and/or Federal tundmg penod Preparer's Signature / //(/l��[6G�Lf�/�C-�tf Date /O/b�lb Authorized Signatur 26,47/�F Date lo((Ol6 See instructions for completing this corm on the next page. Revised. 6/1/06 Attachment H - Grant Closeout- SJH 2S54 xls Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 01/03/16 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT 10% SJH VAX ERF (V ERF) # 2855000000 END DATE 12/31/16 END DATE L CASH REQUEST (CR) 2555 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 19,550.35 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.=1.3.) 19,550.35 IL PROGRAM EXPENSE REPORT (ER) Vax # 2554 I. Total Expenses + Accruals Previously Reported (Through Last Month) 19,550.35 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (II.I +11.2. 11.3.) 19,550.35 ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (11.4.+II.5.=11.6.) 0.00 IIL PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (III. 1 + '11.2 .= I II.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) a`t, I. FINAL CR Contract to Date (1.3.) 19,550.35 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 19,550.35 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES RJ/NOH V. CASH REQUEST PROGRAM INCOME CASH REPORTED ms`s I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P/ Cush Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI. I - VI.2. = VI.3.) (Refund * Extend ) 0.00 VIL MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses lihrough End of Contract (11.3. + 116.+II1.3.) 19,550.35 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (V II.I.) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) YES Hi /NOLJ The Program Income Expense Report and Cash Request can only be extended through the availability of the Award and/or Federal /undmg penod Preparer's Signature {' *!( Date /00 Authorized Signatur � Date q�/6 le 119 / i6 See instructions for completing this form on the next page. Revised. 6/1/06 Attachment H - Grant Closeout- SJH 2S55.xls Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT WP ESF VAX ERF (VERF) # 2W2600000 END DATE 06/30/16 END DATE L CASH REQUEST (CR) 2W26 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 0.00 2. Current Program and Admin Cash Needs (CR # , Column F) 413,682.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.=1.3.) 413 682.00 IL PROGRAM EXPENSE REPORT (ER) Vax # 2854 I. Total Expenses + Accruals Previously Reported (Through Last Month) 413,682.00 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (11.1.+112.=11.3.) 413,682.00 ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (11.4+11.5=11.6.) 0.00 IIL PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (I II.I + 111.2.-111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) hx I. FINAL CR Contract to Date (I.3.) 413,682.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+11I.3.) 413,682.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES L/NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I . + V.2 = V.3.) 0.00 VL RECONCILIATION (PI Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (III.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend ) 0.00 VII- MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + I16.+111.3.) 413,682.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (1/11.2 x VI1.3.) 0.00 5. Total Match Reported (V11.1.) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESLJ /NOEL The Program Income Expense Report and Cash Request can only be extended through the availability o/ the Award and/or Federal lundmg penod Preparer's Signature —)11I -i`�'4��.t «�w� Date/ [ G/ M Authorized Signatur 4/79:6(41 Date41141/4 Sec instructions for completing this form on the next page. Revised- 6/1/06 Attachment H - Grant Closeout -WP ESF 2W26 xis Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 02/15/12 PROGRAM INCOME START DATE YEAR OF FUNDS PY 11 TITLE/PROGRAM/PROJECT H1B VAX ERF (VERF) # 43610000 END DATE 09/30/15 END DATE L CASH REQUEST (CR) 4361x. ; #$ 47,749.43 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 5,985.57 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.1.3.) 53,735.00 H. PROGRAM EXPENSE REPORT (ER) Vax # 2S54 I. Total Expenses + Accruals Previously Reported (Through Last Month) 53,735.00 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (11.1.+11.2.=11.3.) 53,735.00 ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) PCS/23# 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (IL4 +11.5. II.6.) 0.00 III. PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ 111.2.= 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (I.3.) 53,735.00 2. FINAL Expenses Through End of Contract (11.3. + II 6 +III.3.) 53,735.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES H/NOLI V. CASH REQUEST PROGRAM INCOME CASH REPORTED r#Ii I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VL RECONCILIATION (PI Cash Request = PI Expenses) �l= s I. FINAL Program Income Cash (V.3.) 0.00 2, Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI. 1 - V1.2. = VI.3.) (Refund * Extend ) 0.00 VIL MATCH RECONCILIATION Vax #₹r I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 53,735.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VI1.2 x VII.3.) 0.00 5. Total Match Reported (VII.I.) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESH /NOLI The Program Income Expense Report and Cash Request can only be extended through the availability o/ the Award and/or Federal funding period. Preparer's Signature / /1i j��p�i / /1Tl Date JO/ 41/4 Authorized Signatur 'Et/ ' / Date to 0q hi See instructions for completing this form on the next page. Revised: 6/1/06 Attachment H - Grant Closeout -WP ESF 2W26. xis Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/14 PROGRAM INCOME START DATE YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT Disaster NEG VAX ERF (VERF) # 2414/444230000 END DATE 09/30/15 END DATE I. CASH REQUEST (CR) 3PK0I 76,381.47 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/31/2015 ) 2. Current Program and Admin Cash Needs (CR 4 , Column F) 1,937.53 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+I.2.=1.3.) 78,319.00 II. PROGRAM EXPENSE REPORT (ER) Vax # 2S54₹t I. Total Expenses + Accruals Previously Reported (Through Last Month) 78,319.00 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (11.1,+II.2: 11.3.) 78,319.00 ADMINISTRATIVE EXPENSE (ER) Vax d 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (II.4.+11.5: II.6.) 0.00 ILL PROGRAM INCOME (PI) EXPENSE REPORT Vax 4 I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ III.2.= 111.3.) 0.00 LV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) 78,319.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+I11.3.) 78,319.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES Ll/NOU V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend ) 0.00 VIL MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + II6.+111.3.) 78,319.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESiL /NOL The Program Income Expense Report and Cash Request can only be extended through the availability o/ the Award and/or Federal (undmg penod. Preparer's Signature r / '/� iLLf.14� Date f v/!/li Authorized Signatur �� ( Date /O1 fq//6 See instructions for completing this form on the next page. Reseed. 6/1/06 Attachment H - Grant Closeout-NEG 4423 xis Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/14 PROGRAM INCOME START DATE YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT Adult Administration VAX ERF (VERF) # 46A400000 END DATE 06/30/16 END DATE L CASH REQUEST (CR) 46A4 17,567.17 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/31/2015 ) 2. Current Program and Admin Cash Needs (CR /4 , Column F) 32,351.83 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2=1.3.) 49,919.00 II. PROGRAM EXPENSE REPORT (ER) Fax # ,'.. I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (11.1 +II.2=11.3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# 49,919.00 5. Current Expenses + Accruals (Through End Date of Award) 49,919.00 6. FINAL Administrative Expenses Contract to Date (11.4.+II.5=11.6.) III. PROGRAM INCOME (PI) EXPENSE REPORT Fax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1 .+ 111.2.= 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) #!„ 1. FINAL CR Contract to Date (1.3.) 49,919.00 0.00 2. FINAL Expenses Through End of Contract (11.3. + II 6 +III.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES i r /NOLI V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V. I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P/ Cash Request = PI Expenses) '. I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - V1.2. = VI.3.) (Refund * Extend ) VII. MATCH RECONCILIATION Fax #e'°•- = is I. FINAL Match Reported Through End of Contract 49,919.00 2. FINAL Expenses Through End of Contract (II.3. + 116.+111.3.) 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x VII.3.) 5. Total Match Reported (V11.1.) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESIJ /NOLL The Program Income Expense Report and Cash Request can only be extended through the avaAabARy o/ fhe Awwu and/or Fede21 /untlmg penod. e4C)Preparer's Signature / r tt Date /5 % /14 Authorized Signatur 1^��ae Date 10f(9Ili See instructions for completing this form on the next page. Revised. 6/1/06 Attachment H - Grant Closeout -Adult Admin 46A5.xls Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 16 TITLE/PROGRAM/PROJECT Adult Administration VAX ERF (VERF) # 46A500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) 46A5 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/31/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 17,121.27 3. FINAL Program and Admin Cash Needs Contract to Date (1.1 .+1.2.=1.3.) 17,121.27 IL PROGRAM EXPENSE REPORT (ER) Fax 4 2S54 I . Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (11.1.+11.2.-I1.3.) ADMINISTRATIVE EXPENSE (ER) Vax 4. Total Expenses + Accruals Previously Reported (Through Last Month) PCS123# 17,121.27 5. Current Expenses + Accruals (Through End Date of Award) 17.12127 6. FINAL Administrative Expenses Contract to Date (11.4.+II.5. 11.6.) III. PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 0.00 2. Current Program Income Expenses (Through End Date of Contract) 0.00 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ 111.2: 111.3.) IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) 17.12127 0.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+II1.3.) YES Ll/NOLI 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR 4 ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I . + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = PI Expenses) k " I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (III.3.) 0.00 3. Total PI Cash Balance (VI.1 - VI.2. = VI.3.) (Refund * Extend ) VII. MATCH RECONCILIATION Vox # I. FINAL Match Reported Through End of Contract 17.12127 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x VII.3.) 5. Total Match Reported (VIM >or= to Match Expenditure Requirement (V11.4.)? (Check Box) YESLJ /NO Li • The Program Income Expense Report and Cash Request can only be extended through fhe evadabtlRy o/ the Award and/or Federal /undmg penod Preparer's Signature / 1t i-eata Date /0 Iii Authorized Signatur Date /Id (41/4 See instructions for completing this form on the next page. Revised: 6/1/06 Attachment H - Grant Closeout -Adult Admin 46A5.xls Attachment H Page I of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/14 PROGRAM INCOME START DATE YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT DW Administration VAX ERF (VERF) # 46D400000 END DATE 06/30/16 END DATE L CASH REQUEST (CR) 46D4 13,596.64 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/31/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 10,010.36 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+I.2.-1.3.) 23,607.00 IL PROGRAM EXPENSE REPORT (ER) Vax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (11.1,+11.2. II.3.) 0.00 ADMINISTRATIVE EXPENSE (ER) Vax # 1 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# 23,607.00 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (11.4.+11.5.-11.6.) 23,607.00 IIL PROGRAM INCOME (PI) EXPENSE REPORT vax # ?' 1. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 0.00 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ III.2.= 111.3.) IV. RECONCILIATION (Cash Request = Expense) _ 3s I. FINAL CR Contract to Date (1.3.) 23,607.00 0.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) YES LJ/NOLJ 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VL RECONCILIATION (P/ Cush Request = P1 Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - V1.2. = V1.3.) (Refund * Extend ) VIL MATCH RECONCILIATION Vax # t.•' I. FINAL Match Reported Through End of Contract 23,607.00 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x VII.3.) YESH /NOL] 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) The Program Income Expense Report and as Request can only be extended rhrou Signature ' / G,i Date /04/110Preparer's Authorized Signatur A// Date k f (q//6 See instructions for completing this onn on the next page. Revised-. 6/1/06 Attachment H - Grant Closeout -Adult Admin 46A4. xls Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 16 TITLE/PROGRAM/PROJECT DW Administration VAX ERF (VERF) # 46D500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) 46D5 € 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/31/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 12,157.83 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.=1.3.) 12,157.83 H. PROGRAM EXPENSE REPORT (ER) Vax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (II.I +11.2. II.3.) ADMINISTRATIVE EXPENSE (ER) Vax # q 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 12,157.83 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (11.4.+II.5. 11.6.) 12,157.83 III. PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1 + 111.2: 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) 12,157.83 I. FINAL CR Contract to Date (I.3.) 2. FINAL Expenses Through End of Contract (11.3. + II 6.+III.3.) 0.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES L/NOL V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR 4 ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V. I. + V.2 = V.3.) 0.00 VL RECONCILIATION (P/ Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (V1.1 - VI.2. = V1.3.) (Refund * Extend 1 0.00 VII. MATCH RECONCILIATION Vax # _. I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 12,157.83 3. Match Percentage of Expenditure Contractual Requirement 0.00% 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII. 1.3> or = to Match Expenditure Requirement (V11.4.)? (Check Box) _ YESLI /NOL The Program Income Expense Report and Cash Request can only be extended through the ava,labAdy Preparer's Signature( Date /�rl //6 Authorized Signatur 2-1A," ' Date lb( (ilit Sec instructions for completing this form on the next page. Revised 6/1/06 Copy of Attachment H - Grant Closeout-DW Admin 46D5. xis Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 16 TITLE/PROGRAM/PROJECT Adult VAX ERF (VERF) # 48A500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) 48A5 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/31/2015 1 2. Current Program and Admin Cash Needs (CR # , Column F) 349,984.14 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.=1.3.) 349,984.14 II. PROGRAM EXPENSE REPORT (ER) Vax 4 t I. Total Expenses + Accruals Previously Reported (Through Last Month) 349,984.14 2. Current Expenses + Accruals (Through End Date of Award) 349,984.14 3. FINAL Program Expenses Contract to Date (II.I+11.2. 11.3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 5. Current Expenses + Accruals (Through End Date of Award) 0.00 6. FINAL Administrative Expenses Contract to Date (11.4.+11.5. 11.6.) HI. PROGRAM INCOME (PI) EXPENSE REPORT Vax 4 I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1 + 111.2.= 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) 2m I. FINAL CR Contract to Date (1.3.) 349,984.14 2. FINAL Expenses Through End of Contract (11.3. + II 6 +111.3.) 349,984.14 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES LJ/NOH V. CASH REQUEST PROGRAM INCOME CASH REPORTED S1 I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I . + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = P/ Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI. I - V1.2. = VI.3.) (Refund * Extend ) 0.00 VII. MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3.+116.+111.3.) 349,984.14 3. Match Percentage of Expenditure Contractual Requirement 0.00% 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII.I.) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESLJ /NOU • The Program Income Expense Report and Cash Request can only be extended through thequate Ilyar the Award and/or Federal lundmg penod. Preparers Signature / 7 l/11..kh-t Z4 Date /07/A Authorized Signatur 291,7/7ad Date /O'(lilt See instructions for completing this form on the next page. Revised'. 6/1/06 Attachment H - Grant Closeout -Adult 48A5 xls Attachment II Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/14 PROGRAM INCOME START DATE YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT Dislocated Worker VAX ERF (VERF) # 48D400000 END DATE 06/30/16 END DATE L CASH REQUEST (CR) 48D4 183,170.03 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/31/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 29,290.97 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+I.2.=1.3.) 212,461.00 IL PROGRAM EXPENSE REPORT (ER) Ear 4 1. Total Expenses + Accruals Previously Reported (Through Last Month) 212,461.00 2. Current Expenses + Accruals (Through End Date of Award) 212,461.00 3. FINAL Program Expenses Contract to Date (11.1.H-11.2.-11.3.) ADMINISTRATIVE EXPENSE (ER) Fax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCSl23# 5. Current Expenses + Accruals (Through End Date of Award) 0.00 6. FINAL Administrative Expenses Contract to Date (11.4.+II.5. 11.6.) IIL PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ I I I.2.= 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) 212,461.00 212,461.00 2. FINAL Expenses Through End of Contract (11.3. + 116+111.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES L-0/NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # 1 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I . + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (III.3.) 0.00 3. Total PI Cash Balance (VI.I - V1.2. = VI.3.) (Refund * Extend ) VII. MATCH RECONCILIATION Vax 4 I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+III.3.) 212,461.00 3. Match Percentage of Expenditure Contractual Requirement 0.00% 0.00 4. Match Expenditure Requirement (VII.2 x VI1.3.) 5. Total Match Reported (VIII) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESL'_I /NOLL The Program Income Expense Report and Cash Request can only lie extended through the availability o/ the Award and/or Fetleral rundmg penod. Preparer's Signature )727/ Date AA //k / Authorized Signatur � 7,95e� Date (DI edit See instructions for completing this form on the next page. Revised: 6/1/06 Attachment H - Grant Closeout-DW 48D4 xls Attachment H Page I of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 16 TITLE/PROGRAM/PROJECT Dislocated Worker VAX ERF (VERF) # 48D500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) 48D5 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 94,392.56 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2:1.3.) 94,392.56 IL PROGRAM EXPENSE REPORT (ER) Fax # 2S54 3r I. Total Expenses + Accruals Previously Reported (Through Last Month) 94,392.56 2. Current Expenses + Accruals (Through End Date of Award) 94,392.56 t 3. FINAL Program Expenses Contract to Date (IL.I .+II.2. 11.3.) ADMINISTRATIVE EXPENSE (ER) Fax # rxi 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCSI23# 5. Current Expenses + Accruals (Through End Date of Award) 0.00 6. FINAL Administrative Expenses Contract to Date (II.4.+11.5. 11.6.) IIL PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (III. I + 111.2: 111.3.) 0.00 IV RECONCILIATION (Cash Request = Expense) 5 v, I. FINAL CR Contract to Date (1.3.) 94,392.56 94,392.56 2. FINAL Expenses Through End of Contract (11.3. + II 6 +III.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES LI/NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cush Request = P/ Expenses), I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend ) VIL MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116+111.3.) 94,392.56 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x V11.3.) 5. Total Match Reported (VII. I.) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESLJ /NOL • The Program Income Expense Report and Cash Request can only be extended through the ava) l lundmg penod Preparer's Signature L /flA . t' t Date /WM Authorized Signatur 0,7.e/ Date /6 fIlh L Sec instructions for completing this form on the next page. Revised 6/1/06 Attachment H - Grant Closeout-DW 48D5.45 Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT Adult Administration VAX ERF (VERF) # 4A6500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) 4A65 w;;+ 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/31/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 3,972.00 3. FINAL Program and Admin Cash Needs Contract to Date (1. L+I.2. 1.3.) 3,972.00 II. PROGRAM EXPENSE REPORT (ER) Fax # $ `= +^ I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (11.1.+112. 11.3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 3,972.00 5. Current Expenses + Accruals (Through End Date of Award) 3,972.00 6. FINAL Administrative Expenses Contract to Date (11.4.+IL5. 11.6.) HL. PROGRAM INCOME (PI) EXPENSE REPORT Fax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 0.00 3. TOTAL PI Expenses Through End Date of Contract (III.l.+ 111.2. 111.3.) IV. RECONCILIATION (Cash Request = Expense) 'r,+, I. FINAL CR Contract to Date (1.3.) 3,972.00 0.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES LJ/NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P1 Cash Request = Pt Expenses) 0.00 I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (III.3.) 0.00 3. Total PI Cash Balance (VI.I - V1.2. = V1.3.) (Refund * Extend ) VII. MATCH RECONCILIATION Fax I. FINAL Match Reported Through End of Contract 3,972.00 2. FINAL Expenses Through End of Contract (11.3. + 116.+III.3.) 0.00% 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VI1.2 x VI1.3.) 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) _ YESI /NOLL • The Program Income Expense Report and Cash Request can only be extended through the av Preparer's Signature -717/8a4.1.62 Date A01/40 Signatur �'YN 41 l Date //ohq' /6 Sec instructions for completing this form on the next page. Revised'. 6/1/06 Attachment H - Grant Closeout -Adult Admin 4A65.xls Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT WIOA Adult VAX ERF (VERF) # 4A8500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) 4A85 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/31/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 35,748.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.1.3.) 35,748.00 IL PROGRAM EXPENSE REPORT (ER) Vax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 35,748.00 2. Current Expenses + Accruals (Through End Date of Award) 35,748.00 3. FINAL Program Expenses Contract to Date (11.1 +II.2: II.3.) ADMINISTRATIVE EXPENSE (ER) Vax # (_ S 4. Total Expenses + Accruals Previously Reported (Through Last Month) ECSI23# 0.00 5. Current Expenses + Accruals (Through End Date of Award) 0.00 6. FINAL Administrative Expenses Contract to Date (II.4.+11.5.=11.6.) IIL PROGRAM INCOME (PI) EXPENSE REPORT Vax # p, I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 0.00 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ 111.2: 111.3.) IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) 35,748.00 35,748.00 2. FINAL Expenses Through End of Contract (II.3. + II 6 +III.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES Liz /NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED 1 0.00 I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P/ Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (II1.3.) 0.00 3. Total PI Cash Balance (VI.1 - VI.2. = VI.3.) (Refund * Extend ) VIL MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 35,748.00 2. FINAL Expenses Through End of Contract (II.3. + 116+111.3.) 0.00% 3. Match Percentage of Expenditure Contractual Requirement 0,00 4. Match Expenditure Requirement (VII.2 x VII.3.) 5. Total Match Reported (V II.I.)> or = to Match Expenditure Requirement (V11.4.)? (Check Box) YES I J /NOLJ The Program Income Expense Report and Cash Request can only be extended through the aye, labHilo / the Award and/or Federal /undmg penod. Preparer's Signature -721/ / / Date /44 PL Authorized Signatur 1.9-e Date et- I (i'/6 Sec instructions for completing this form on the next page. Revised: 6/1/06 Attachment H - Grant Closeout -Adult 4A85. xis Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/14 PROGRAM INCOME START DATE YEAR OF FUNDS FY 14 TITLE/PROGRAM/PROJECT DW Admin Trans Mt VAX ERF (VERF) # 4BD400000 END DATE 06/30/16 END DATE L CASH REQUEST (CR) 4BD4 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 23,607.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.=1.3.) 23,607.00 II. PROGRAM EXPENSE REPORT (ER) Vax # 2S54 I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (11.1 +11.2. II.3.) ADMINISTRATIVE EXPENSE (ER) Vax 4 4. Total Expenses + Accruals Previously Reported (Through Last Month) PCS123# 23,607.00 5. Current Expenses + Accruals (Through End Date of Award) 23,607.00 6. FINAL Administrative Expenses Contract to Date (II.4.+11.5.-11.6.) III. PROGRAM INCOME (PI) EXPENSE REPORT Vax # q' I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 0.00 3. TOTAL PI Expenses Through End Date of Contract (III. I.+ 111.2.= 111.3.) IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) 23,607.00 0.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES i_'J/NOLI V. CASH REQUEST PROGRAM INCOME CASH REPORTED _ z I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P1 Cush Reques( = P/ Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.1 - VI.2. = V I.3.) (Refund * Extend ) VII. MATCH RECONCILIATION Vat; # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116 +111.3.) 23,607.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII.I.) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESU/NOL The Program Income Expense Report and Cash Request can only be extended through the avaAabtbty o/ the Award and/or Federal /undmg penod Preparer's Signature / /14^RL.‘4L19"C/ Date /0/4 Authorized Signatur e4 Date 1O ltl/Ii See instructions for completing this form on the next page. Revised. 611/06 Attachment H - Grant Closeout-DW trans Adult Admin 4BD4.xls Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 16 TITLE/PROGRAM/PROJECT DW Admin. trx to Adt VAX ERF (VERF) # 4BD500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) 4A65 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/31/2015 ) 0.00 2. Current Program and Admin Cash Needs (CR # , Column F) 3,317.00 3. FINAL Program and Admin Cash Needs Contract to Date (I.I +1.2:1.3.) 3,317.00 IL PROGRAM EXPENSE REPORT (ER) Vex # u# I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (II. I.+11.2. I1.3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# 3,317.00 5. Current Expenses + Accruals (Through End Date of Award) 3,317.00 6. FINAL Administrative Expenses Contract to Date (11.4 +11.5. 11.6.) lit PROGRAM INCOME (PI) EXPENSE REPORT Vex # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ II1.2. 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense): I. FINAL CR Contract to Date (1.3.) 3,317.00 0.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES LJ/NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VL RECONCILIATION (P/ Cash Request = P/ Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (II1.3.) 0.00 3. Total PI Cash Balance (VI.1 - VI.2. = VI.3.) (Refund * Extend ) VIL MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+III.3.) 3,317.00 0.00% 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x V11.3.) YESLJ /NOIJ 5. Total Match Reported (VII.] .) > or = to Match Expenditure Requirement (VI1.4.)? (Check Box) The Program Income Expense Report and as Request can only be extended rnrou Preparer's Signature i Date /0/41/,6 Authorized Signatur ,e t 'EEIa % ! 11 Date MO 1(6 See instructions for completing this form on the next page. Revised: 6/1/06 Attachment H - Grant Closeout-DW Admin Trx Adult 4BD5.xls Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT DW Admin. VAX ERF (VERF) # 4D6500000 END DATE 06/30/17 END DATE I. CASH REQUEST (CR) 4A65 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/31/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 3,317.00 3. FINAL Program and Admin Cash Needs Contract to Date 0.1.+I.2.=1.3.) 3,317.00 IL PROGRAM EXPENSE REPORT (ER) Vax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (II. 1.+11.2.=l1.3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# 3,317.00 5. Current Expenses + Accruals (Through End Date of Award) 3,317.00 6. FINAL Administrative Expenses Contract to Date (11.4 +II.5. II.6.) IIL PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ 111.2.= 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) ,. > I. FINAL CR Contract to Date (1.3.) 3,317.00 0.00 2. FINAL Expenses Through End of Contract (11.3. + II 6,+111.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES'_ /NOH V. CASH REQUEST PROGRAM INCOME CASH REPORTED yu 0.00 I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P/ Cash Request = P1 Expenses) II r�. I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - V1.2. = VI.3.) (Refund * Extend ) VIL MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.1-III.3.) 3,317.00 0.00% 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x VII.3.) 5. Total Match Reported (VII.I.)>or=to Match Expenditure Requirement (VIL4.)?(Check Box) YES±/NOLJ The Program Income Expense Report and Cash Request can only Preparer's Signature / z /l Date /0/O Authorized Signatur �/� Date lot Ml lb Sec instructions for completing this form the next page. Revised: 6/1/06 Attachment -I - Grant Closeout -00V Admin 4D65.xls Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT/EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT 25% Enhanced DW I VAX ERF (VERF) # 4D7500000 END DATE 06/30/17 END DATE I CASH REQUEST (CR) 4D75 0.00 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/31/2015 1 2. Current Program and Admin Cash Needs (CR # , Column F) 2,195.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1 .+1.2.=I.3.) 2,195.00 IL PROGRAM EXPENSE REPORT (ER) Vax # $ff I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (11.1+11.2=11.3.) ADMINISTRATIVE EXPENSE (ER) Vax #*f 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 2,195.00 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (11.4 +11.5. II.6.) 2,195.00 III PROGRAM INCOME (PI) EXPENSE REPORT Fax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (III. I.+ II1.2: 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) 2,195.00 I. FINAL CR Contract to Date (1.3.) 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 0.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES Ld/NOH V. CASH REQUEST PROGRAM INCOME CASH REPORTED yak I. Total PI Cash Previously Reported on CR (Last CR (4 ) 0.00 2. Current Program Income Cash (Through End Date of Contract) (CR (4 , column G) 3. FINAL Program Income Cash Contract to Date (V.1. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (III.3.) 3. Total PI Cash Balance (VI.I - V1.2. = VI.3.) (Refund * Extend ) 0.00 VII MATCH RECONCILIATION Vax #}r� I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 2,195.00 3. Match Percentage of Expenditure Contractual Requirement 0.00% 4. Match Expenditure Requirement (VIL2 x VII.3.) 0.00 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (V11.4.)? (Check Box) YESLLJ /NOLJ The Program Income Expense Report and Cash Request can only be extended through the availability o/ roe Award and/or Federal tundmg penod. Preparer's Signature - /��,GGlLtia Date p Authorized Signatur 29,d)617 //b/b/I Date 4 1,1/it See instructions for completing this form on the next page. Revised'. 6/1/06 Attachment H - Grant Closeout -Ent OW Admin 4075 xis Attachment H Page 1 of 2 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 07/01/13 PROGRAM INCOME START DATE YEAR OF FUNDS PY 13 TITLE/PROGRAM/PROJECT Adult VAX ERF (VERF) # 2361 END DATE 06/30/16 END DATE L CASH REQUEST (CR) VAX CR# 1847 3NAD2F I. Total Program and Admin Cash Needs Previously Reported (Last CR # 1847 ) 10,000.00 2. Current Program and Admin Cash Needs (CR # , Column F) 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.=1.3.) 10,000.00 II. PROGRAM EXPENSE REPORT (ER) Vax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (11.1.+II.2.=11.3.) ADMINISTRATIVE EXPENSE (ER) vax # 2361 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# 3AD02F # 10,000.00 5. Current Expenses + Accruals (Through End Date of Award) 10,000.00 6. FINAL Administrative Expenses Contract to Date (II.4.+II.5.—II.6.) III PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (III.1 + 111.2: 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) 1. FINAL CR Contract to Date (I.3.) If not, explain on the Remark below 10,000.00 10,000.00 2. FINAL Expenses Through End of Contract (11.3. + II 6 +II1.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES LJ/NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P1 Cash Request = P/ Expenses) 1. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend I VII MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (II.3. + 116 +111.3.) 10,000.00 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x VII.3.) 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (V11.4.)? (Check Box) YESL /NOLJ The Program Income Expense Report and as Request can only tIVfilif fn Preparer's Signature 711 � �L`Er "'T""� Date /4/4 /ii Authorized Signatur 2 469 Date bit i II L See instructions for completing this rohi1 on the next page. Revised'. 6/1/06 2015AttachHCloseRec2361B xlsx Attachment H Page I of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 07/01/13 PROGRAM INCOME START DATE YEAR OF FUNDS PY 13 TITLE/PROGRAM/PROJECT Adult VAX ERF (VERF) # 2361 END DATE 06/30/16 END DATE L CASH REQUEST (CR) VAX CR# 1847 3NAD3F I. Total Program and Admin Cash Needs Previously Reported (Last CR # 1847 1 6,037.90 2. Current Program and Admin Cash Needs (CR # , Column F) 3. FINAL Program and Admin Cash Needs Contract to Date (1.1 +1.2.=1.3.) 6,037.90 H. PROGRAM EXPENSE REPORT (ER) Fax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (11.1.+II.2. II.3.) 0.00 ADMINISTRATIVE EXPENSE (ER) Vax # 2361 ,. 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 3AD03F # 6,037.90 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (II.4.+6.5.=11.6.) 6,037.90 IIL PROGRAM INCOME (PI) EXPENSE REPORT Vax # I . Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ II1.2. III.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense)`. I. FINAL CR Contract to Date (1.3.) If not, explain on the Remark below 6,037.90 6,037.90 2. FINAL Expenses Through End of Contract (11.3. + 11 6.+111.3.) YES L/NOLJ 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) V. CASH REQUEST PROGRAM INCOME CASH REPORTED 1. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P/ Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI. I - VI.2. = V1.3.) (Refund * Extend ) VII. MATCH RECONCILIATION Vax # a I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116+II1.3.) 6,037.90 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VIl.2 x VII.3.) YESL'J /NOLJ 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) The Program Income Expense Report and as Request can only Hemerk: Preparer's Signature/ Date /0//4 Authorized Signatur Date Ffl hi i a di� See instructions for completing this form on the next page. Revised 6/1/06 2015AttachHCloseRec2361 F.xlsx Attachment H Page I of COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT WIOA DW VAX ERF (VERF) # 4D8500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) VAX CR# 1847 4D85is"w' I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 21,869.68 2. Current Program and Admin Cash Needs (CR # , Column F) 7,983.32 3. FINAL Program and Admin Cash Needs Contract to Date (1.I.+1.2.=1.3.) 29,853.00 H. PROGRAM EXPENSE REPORT (ER) Vax # 4D85 I. Total Expenses + Accruals Previously Reported (Through Last Month) 21,869.68 2. Current Expenses + Accruals (Through End Date of Award) 7,983.32 3. FINAL Program Expenses Contract to Date (11.1.+11.2.=1I.3.) 29,853.00 ADMINISTRATIVE EXPENSE (ER) Vax # 4D85 g r, 0.00 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# # 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (11.4.-111.5.-I1.6.) 0.00 III. PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1,+ 111.2: 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) If not, explain on the Remark below 29,853.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 29,853.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES LH/NOLL V. CASH REQUEST PROGRAM INCOME CASH REPORTED _ I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P/ Cash Request = P/ Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend ) 0.00 VIL MATCH RECONCILIATION vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3) 29,853.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII.I.)>or= to Match Expenditure Requirement (VII.4.)? (Check Box) Y YESLI /NOI,J The Program Income Expense Report and Cash Request can only be extended through the availability of the Award and/or Federal funding period. Preparer's Signature ehieti`�J�'� Date /,4,/i Authorized Signatur %21S7 % / Date t!.O 1(1 la See instructions for completing this form on the next page. Revised: 6/1/06 Attachment H WIOA DW 4D85.xlsx Attachment H Page 1 of 1 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT WIOA 25% Enhance, VAX ERF (VERF) # 4/39500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) VAX CR# 1847 4D95 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 0.00 2. Current Program and Admin Cash Needs (CR # , Column F) 18,452.51 3. FINAL Program and Admin Cash Needs Contract to Date (I.I.+1.2. I.3.) 18,452.51 IL PROGRAM EXPENSE REPORT (ER) Vax # 4D95 I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 18,452.51 18,452.51 3. FINAL Program Expenses Contract to Date (11.1.+11.2.=11.3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4D85 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# 4 0.00 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (11.4+11.5=11.6.) 0.00 III. PROGRAM INCOME (PI) EXPENSE REPORT Vax 4 I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ 111.2.= 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) I/ not, explain on the Remark below 18,452.51 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 18,452.51 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES H/NOH V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I . + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = P1 Expenses)l I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (I II.3.) 0.00 3. Total PI Cash Balance (Vl.l - V1.2. = VI.3.) (Refund * Extend 1 0.00 VII. MATCH RECONCILIATION Vax #I I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (II.3. +116.4-111.3.) 18,452.51 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII. I.) > or= to Match Expenditure Requirement (VII.4.)? (Check Box) YESH /NOIH / th The Program Income Expense Report and Cash Request can only be extended through the oval abldy oe Award and/or Federal /undmg penod. Preparer's Signature -)11/0414. z */1,4000 (L-.yt.4 Date /4104/4 Authorized Signatur 72,-1 Date le hi ) )I See instructions for completing this form on the next page. Revised: 6/1/06 Attachment H Enh OW 4095 xlsx Attachment H Page I of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT WIOA DW VAX ERF (VERF) # 4DN500000 END DATE 06/30/17 END DATE I. CASH REQUEST (CR) VAX CR# 1847 4DN5 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 0.00 2. Current Program and Admin Cash Needs (CR # , Column F) 29,853.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2:1.3.) 29,853.00 II. PROGRAM EXPENSE REPORT (ER) Lax # 4DN5 t I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 29,853.00 3. FINAL Program Expenses Contract to Date (II.1.+11.2: 11.3.) 29,853.00 ADMINISTRATIVE EXPENSE (ER) Lax # 4DN5 j' .. 4. Total Expenses + Accruals Previously Reported (Through Last Month) ECS1234 4 0.00 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (II.4.+11.5.=11.6.) 0.00 HI. PROGRAM INCOME (PI) EXPENSE REPORT Lax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.-1- II1.2. 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) If not, explain on the Remark below 29,853.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 29,853.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES H/NOU V. CASH REQUEST PROGRAM INCOME CASH REPORTED #} s I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VL RECONCILIATION (P/ Cash Rennes, = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VLI - VI.2. = VI.3.) (Refund * Extend ) 0.00 VII. MATCH RECONCILIATION Lax # .., _. I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + I16.+111.3,) 29,853.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII.I.) > or= to Match Expenditure Requirement (VII.4.)? (Check Box) YESLI /NOLJ • The Program Income Expense Report and Cash Request can only be extended through the availability o/ the Award and/or Federal funding penoo. Preparer's Signature l / /44!126eD Date /V/6//Y Authorized Signatur ,� ,;/ t Date /b l6 Ig See instructions for completing this form on the next page. Revised 6/1/06 Attachment H WIOA DW 40N5 xlsx Attachment H Page 1 of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 16 TITLE/PROGRAM/PROJECT Enhanced DW Admir VAX ERF (VERF) # 4ED500000 END DATE 06/30/17 END DATE I. CASH REQUEST (CR) VAX CR# 1847 4ED5 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) ra 0.00 2. Current Program and Admin Cash Needs (CR # , Column F) 5,122.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1+1.2=1.3.) 5,122.00 II. PROGRAM EXPENSE REPORT (ER) Vax # 4DN5 7` I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (11.1.+11.2.=l1.3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4DN5 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# # 5,122.00 5. Current Expenses + Accruals (Through End Date of Award) 5,122.00 6. FINAL Administrative Expenses Contract to Date (11.4.+II.5. 11.6.) III. PROGRAM INCOME (PI) EXPENSE REPORT Vax 4 )@ I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 0.00 3. TOTAL PI Expenses Through End Date of Contract (111.1+ 111.2: 111.3.) IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) II not, explain on the Remark below 5,122.00 5,122.00 2. FINAL Expenses Through End of Contract (11.3. + 11 6.+11I.3.) YES Hi /NOH 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = Pt Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (II1.3.) 0.00 3. Total PI Cash Balance (VI.I - V1.2. = VI.3.) (Refund * Extend ) VII. MATCH RECONCILIATION Vax 4 fat, I. FINAL Match Reported Through End of Contract 5,122.00 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VI1.2 x V II.3.) 5. Total Match Reported (VII.I.)>or=to Match Expenditure Requirement (V11.4.)? (Check Box) d' d YESLI /NO Li bdRy The Program Income Expense Report and Cash Request can only be extended through the evatlao/ the AwaN and/or Fede2 un mg peno . nemanc: -----#(� Preparer's Signature Date /ib Authorized Signatur ��a Date //3/4 (i ((tj /Ir; See Instructions for completing this form on the next page. Revised: 6/1/06 Attachment H Enh DW Admin 4ED5.xlsx Attachment H Page I of 1 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 10/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 14 TITLE/PROGRAM/PROJECT Enhanced DW VAX ERF (VERF) # 4KD300000 END DATE 06/30/16 END DATE L CASH REQUEST (CR) VAX CR# 1847 4KD3 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 0.00 2. Current Program and Admin Cash Needs (CR # , Column F) 48,785.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.=1.3.) 48,785.00 IL PROGRAM EXPENSE REPORT (ER) Vax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 48,785.00 2. Current Expenses + Accruals (Through End Date of Award) 48,785.00 3. FINAL Program Expenses Contract to Date (11.1 +11.2.=11.3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) ECS/23# # 0.00 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (11.4 +11.5 =II.6.) 0.00 IlL PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (I I I. I.+ 111.2.= 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense), I . FINAL CR Contract to Date (1.3.) If not, explain on the Remark below 48,785.00 48,785.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) YES L /NOLJ 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (H Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.] - VI.2. - VI.3.) (Refund * Extend ) VII. MATCH RECONCILIATION Vax # _ 1 I. FINAL Match Reported Through End of Contract 48,785.00 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VIL2 x VII.3.) 0.00 YESLJ /NOLJ 5. Total Match Reported (VIII) > or = to Match Expenditure Requirement (V11.4.)? (Check Box) The Program Income Expense Report and as Request can only Remark; ---- Pre arer's Signature ' '�'('��I/fi�1��-/��/f�'�`C �-I Date lol6�la Authorized Signatur jl(/� (l`/�y/ ! Date Oki lO1 l lit See instructions for completing this form on the next page. Revised. 6/1/06 Attachment H Enh DW 4KD3.xlsx Attachment H Page I of 1 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 11/20/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT 3.75% Performance I VAX ERF (VERF) # 4LD400000 END DATE 06/30/16 END DATE . CASH REQUEST (CR) VAX CR1t 1847 4LD4 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 0.00 2. Current Program and Admin Cash Needs (CR # , Column F) 16,971.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.I.+1.2.=1.3.) 16,971.00 II. PROGRAM EXPENSE REPORT (ER) Vax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 16,971.00 2. Current Expenses + Accruals (Through End Date of Award) 16,971.00 3. FINAL Program Expenses Contract to Date (11.1.+11.2=11 3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# # 0.00 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (I1.4.+II.5. 11.6.) 0.00 III. PROGRAM INCOME (PI) EXPENSE REPORT Vax # 1. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ 111.2.= III.3.) 0.00 IV RECONCILIATION (Cash Request = Expense) : I. FINAL CR Contract to Date (1.3.) If not, explain on the Remark below 16,971.00 16,971.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) YES LI/NOH 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.1. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P/ Cash Request = P/ Expenses) _ I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI 3.) (Refund * Extend ) VII. MATCH RECONCILIATION Vax # `. I . FINAL Match Reported Through End of Contract 16,971.00 2. FINAL Expenses Through End of Contract (11.3. + II6.+111.3.) 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x VI1.3.) 5. Total Match Reported (VII.] .) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESLJ /NOLJ ' The Program Income Expense Report and Cash Request can only be ex Remark: ^^y,/, Preparer's Signature / / !/(// Date /b/G/lf/I Authorized Signatur 1 Date IelOhl See instructions for completing this form on the next page. Revised. 6/1/06 Attachment H 3.75% PI 4LD4 xlsx Attachment H Page 1 of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 07/01/14 PROGRAM INCOME START DATE YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT Dislocated Worker VAX ERF (VERF) # 4ND400000 END DATE 06/30/16 END DATE I. CASH REQUEST (CR) VAX CR# 1847 4ND4 I. Total Program and Admin Cash Needs Previously Reported (Last CR 4 6/30/2015 ) ( a ieL. y.-1 80,241.14 2. Current Program and Admin Cash Needs (CR 4 , Column F) 132,219.86 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+I.2.1.3.) , 212,461.00 II. PROGRAM EXPENSE REPORT (ER) Vax # 4ND4 1. Total Expenses + Accruals Previously Reported (Through Last Month) 80 2-41.14 132,219.86 2. Current Expenses + Accruals (Through End Date of Award) 212,461.00 3. FINAL Program Expenses Contract to Date (11.1.+11.2.=11.3.) ADMINISTRATIVE EXPENSE (ER) Vax 4 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# 4 0.00 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (II.4.+11.5.=11.6.) 0.00 ILL PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract @II.].+ III.2. 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense)( I. FINAL CR Contract to Date (1.3.) If not, expiate on the Remark below 212,461.00 212,461.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) YES LJ/NO LJ 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = P1 Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - V1.2. = VI.3.) (Refund * Extend ) VII. MATCH RECONCILIATION Vax 4 I. FINAL Match Reported Through End of Contract 212,461.00 2. FINAL Expenses Through End of Contract (11.3. + II6.+III.3.) I.3.) 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x VII.3.) YESL'J /NOLII 5. Total Match Reported (VII.I.)>or= to Match Expenditure Requirement (V11.4.)? (Check Box) The Program Income Expense Report and as Request can only be extended through the avauaouimy o/ the Award and/or Federal /undmg peso Remark: / Preparer's Signature / � Date % ! 0/6//�r / Authorized Signatur "4/7...771 / . Date (O I (-1 I ft Sec instructions for completing this form on the next page. Revised. 611/06 Attachment H DW 4ND4.xlsx Attachment H Page I of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 01/22/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 15 TITLE/PROGRAM/PROJECT 25% DW Hire CO VAX ERF (VERF) # 4OD400000 END DATE 12/31/16 END DATE L CASH REQUEST (CR) VAX CR# 1847 4OD4 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 12,655.09 3. FINAL Program and Admin Cash Needs Contract to Date (1.I.+1.2:1.3.) 12,655 09 II. PROGRAM EXPENSE REPORT (ER) Vax #"- I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 0.00 3. FINAL Program Expenses Contract to Date (11.1+112=11.3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4OD4 3 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# # 0.00 5. Current Expenses + Accruals (Through End Date of Award) 12,655.09 12,655.09 6. FINAL Administrative Expenses Contract to Date (II.4.+II.5. 11.6.) HL PROGRAM INCOME (PI) EXPENSE REPORT Vax 4 fi I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses ("through End Date of Contract) 0.00 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ 111.2: 111.3.) IV. RECONCILIATION (Cash Request = Expense) tre I. FINAL CR Contract to Date (1.3.) If not, explain on the Remark below 12,655.09 12,655.09 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES Lit V CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR 4 , column G) 3. FINAL Program Income Cash Contract to Date (V.1. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P1 Cash Request = P/ Expenses) $a5 I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend ) VIL MATCH RECONCILIATION Vax 4 b' I. FINAL Match Reported Through End of Contract 12,655.09 2. FINAL Expenses Through End of Contract (11.3. + II6 +111.3.) 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x V11.3.) 5. Total Match Reported (V I1.1.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESLI /NOLI The Program Income Expense Report and Cash Request can only be extended through the avanaontry o/ fhe Award and/funding or Federal penod rten,en,. Preparer's Signature/e Date Authorized Signatur /./D'r,��Q¢� j //944 Date 4 4( 411 6 See instructions for completing this form on the next page. Revised. 60/06 Attachment H DW Hire CO Admin 40D4.xlsx Attachment H Page I of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 01/22/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 15 TITLE/PROGRAM/PROJECT 25% DW Hire CO VAX ERF (VERF) # 4PD400000 END DATE 12/31/16 END DATE . CASH REQUEST (CR) VAX CR# 1847 4PD4 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 114,897.48 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2=L3.) 114,897.48 II. PROGRAM EXPENSE REPORT (ER) Vax I. Total Expenses + Accruals Previously Reported (Through Last Month) _ 0.00 2. Current Expenses + Accruals (Through End Date of Award) 114,897.48 3. FINAL Program Expenses Contract to Date (II. 11+11.2=11.3.) 114,897.48 ADMINISTRATIVE EXPENSE (ER) Vax # 4OD4 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# # 0.00 5. Current Expenses + Accruals (Through End Date of Award) 0.00 6. FINAL Administrative Expenses Contract to Date (11.4.+11.5.=11.6.) 0.00 III. PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (III.1.+ 111.2.= 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) II not, explain on the Remark below 1 14,897.48 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 114,897.48 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES H/NOL V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V. I. + V.2 = V.3.) 0.00 VL RECONCILIATION (PI Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.1 - VI.2. = VI.3.) (Refund * Extend ) 0.00 VIL MATCH RECONCILIATION Fax I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + II6+111.3.) 114,897.48 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII.1.) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESLJ /NOLJ 'yea extended through the availability o/ the Award and/or Federal funding period. Remark. Preparer's Signature Date /64# Authorized Signatur /�_�f2' Date (D h ( l Ig See instructions for completing this form on the next page. Revised 60/06 Attachment H OW Hire CO Admin 40D4.xlsx Attachment H Page I of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 08/24/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 15 TITLE/PROGRAM/PROJECT SP NEG Planning VAX ERF (VERF) # 4S3500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) VAX CR# 1847 4S35 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 25,239.17 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.=1.3.) 25.239.17 IL PROGRAM EXPENSE REPORT (ER) Vax # 4S35 I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 25,239.17 2. Current Expenses + Accruals (Through End Date of Award) 25,239.17 3. FINAL Program Expenses Contract to Date (11.1.+Il.2. 11.3.) ADMINISTRATIVE EXPENSE (ER) Vax # f 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# # 0.00 5. Current Expenses + Accruals (Through End Date of Award) 0.00 0.00 6. FINAL Administrative Expenses Contract to Date (11.4.+11.5.=l1.6.) III. PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1+ 111.2: 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense). 25,239.17 1. FINAL CR Contract to Date (1.3.) If not, explain on the Remark below 25,239.17 2. FINAL Expenses Through End of Contract (11.3. + II 6+111.3.) YES t!/NOL! 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) V. CASH REQUEST PROGRAM INCOME CASH REPORTED'. I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VL RECONCILIATION (PI Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I- VL2.= V1.3.) (Refund * Extend ) VIL MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 25,239.17 2. FINAL Expenses Through End of Contract (11.3. +116.+111.3.) 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (5/11.2 x VI1.3.) YESLI /NOL 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (V II.4.)? (Check Box) The Program Income Expense Report and Cash Request can only be ex Remark: ./��'�y_///,��,/� Preparer's Signature / z /�ea,I��,>'uf�(!/ Date P1/b1/4 Authorized Signatur "1✓S:6V17 Date to ) f iII I i+ Sec instructions for completing this form on the next page. Revised 6/1/06 Attachment H SP NEG Planning 4535 xlsx Attachment II Page I of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 08/24/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 15 TITLE/PROGRAM/PROJECT SP NEG Admininstra VAX ERF (VERF) # 4S4500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) VAX CR# 1847 4S45 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) ,ft...? 2. Current Program and Admin Cash Needs (CR # , Column F) 22,782.00 3. FINAL Program and Admin Cash Needs Contract to Date (I.I.+1.2:1.3.) 22,782.00 IL PROGRAM EXPENSE REPORT (ER) Fax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (II.I.+II2: I1.3.) 0.00 ADMINISTRATIVE EXPENSE (ER) Fax # 4S45 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# # 0.00 5. Current Expenses + Accruals (Through End Date of Award) 22,782.00 6. FINAL Administrative Expenses Contract to Date (11.4.+II.5: 11.6.) 22,782.00 III PROGRAM INCOME (PI) EXPENSE REPORT Max # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (I I L I + 111.2.= 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense)) I. FINAL CR Contract to Date (1.3.) II not, explain on the Remark below 22,782.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 22,782.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES L/NOLL V. CASH REQUEST PROGRAM INCOME CASH REPORTED as I. Total PI Cash Previously Reported on CR (Last CR # 1 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI RECONCILIATION (PI Cash Request = P/ Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total P1 Cash Balance (VI.1 - VI.2. = V1.3.) (Refund * Extend ) 0.00 VIL MATCH RECONCILIATION Vex # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + II6.+111.3.) 22,782.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESL /NOLL The Program Income Expense Report and Cash Request can only be extended through the availability of the Award and/or Fetleral /undmg penod Preparer's Signature / itr[/G /44,,11 {'I�L�' Date /Q/�j1 �Io Authorized Signatur G/A/ �/�//'Jti / / Date 'oh(1I/1, Sec instructions for completing this form on the next page. Revised. 6/1/06 Attachment H SP NEG Admin 4R45.xlsx Attachment H Page I of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 08/24/15 PROGRAM INCOME START DATE YEAR OF FUNDS FY 15 TITLE/PROGRAM/PROJECT SP NEG Program VAX ERF (VERF) # 4S5500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) VAX CR# 1847 4S55 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 1: 2. Current Program and Admin Cash Needs (CR # , Column F) 180,601.10 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2:1.3.) 180,601.10 IL PROGRAM EXPENSE REPORT (ER) Vax 4 4S55 I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 180,601.10 180,601.10 3. FINAL Program Expenses Contract to Date (II.I +II.2. 11.3.) ADMINISTRATIVE EXPENSE (ER) Vax #'.. 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# # 0.00 5. Current Expenses + Accruals (Through End Date of Award) 0.00 6. FINAL Administrative Expenses Contract to Date (11.4,+I1.5. 11.6.) IIL PROGRAM INCOME (PI) EXPENSE REPORT Vex # ". I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 0.00 3. TOTAL PI Expenses Through End Date of Contract (I I I.I + 111.2.= 111.3.) IV. RECONCILIATION (Cash Request = Expense) , I. FINAL CR Contract to Date (I.3.) If not, explain on the Remark below 180,601.10 180,601.10 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES L-0/NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED`. I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.1. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend ) 0.00 VII. MATCH RECONCILIATION Vax # b I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 180,601,10 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x V11.3.) 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) YES/ J /NOLJ " The Program Income Expense Report and Cash Request can only be extended through the avatte i t y o/ the Award and/or Federal (untlmg penod Rema,R. Preparer's Signature )(i Date /e/4//k Authorized Signatur „1„41--/, Date 010 ) 6 See instructions for completing this form on the next page. Revised 6/1/06 Attachment H SP NEG 4S55.xlsx Attachment H Page 1 of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 10/01/14 PROGRAM INCOME START DATE YEAR OF FUNDS FY 15 TITLE/PROGRAM/PROJECT 25% TAA Case Mgm VAX ERF (VERF) # 4T0400000 END DATE 06/30/16 END DATE L CASH REQUEST (CR) VAX CR# 1847 4TD4 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 2. Current Program and Admin Cash Needs (CR # , Column F) 20,000.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.=1.3.) 20,000.00 IL PROGRAM EXPENSE REPORT (ER) Vax # 4TD4 f p s a I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 20,000.00 2. Current Expenses + Accruals (Through End Date of Award) 20,000.00 3. FINAL Program Expenses Contract to Date (11.1 +11.2. 11.3.) ADMINISTRATIVE EXPENSE (ER) vax # 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# 4 0.00 5. Current Expenses + Accruals (Through End Date of Award) 6. FINAL Administrative Expenses Contract to Date (I I.4.+II.5 =11.6.) 0.00 III. PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 0.00 3. TOTAL PI Expenses Through End Date of Contract (I II.I + 111.2.= 111.3.) IV. RECONCILIATION (Cash Request = Expense) "? I. FINAL CR Contract to Date (1.3.) If not, explain on the Remark below 20,000 00 20,000.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) YES LJ/NO L 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) V. CASH REQUEST PROGRAM INCOME CASH REPORTED x. I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V. I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = P/ Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (III.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend ) VIL MATCH RECONCILIATION Vax # L Ir I. FINAL Match Reported Through End of Contract 20,000.00 2. FINAL Expenses Through End of Contract (11.3. + 116.+111.3.) 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x VII.3.) YESLI /NOLJ 5. Total Match Reported (VII. L) > or = to Match Expenditure Requirement (VI1.4.)? (Check Box) • The Program Income Expense Report and as Request can only be exfende nemara Preparer's Signature / y/n/J�� ff\\ IL_At_1.�i is Date / /Q/6//`' Authorized Signatur sja Date (O ( (1 /it See instructions for completing this term on the next page. Revised. 611/06 Attachment H 25% TAA Case Mgmt 4704.xlsx Attachment H Page 1 of 1 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 07/01/14 PROGRAM INCOME START DATE YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT Youth Administration VAX ERF (VERF) # 4Y6400000 END DATE 06/30/16 END DATE . CASH REQUEST (CR) VAX CRa 1847 4Y64 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 13,495.19 2. Current Program and Admin Cash Needs (CR # , Column F) 36,935.91 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.=1.3.) 50,431.10 II. PROGRAM EXPENSE REPORT (ER) Vax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (11.1 +II.?: II.3.) 0.00 ADMINISTRATIVE EXPENSE (ER) Vax # 4Y64. , 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# # 13,495.19 5. Current Expenses + Accruals (Through End Date of Award) 36,935.91 6. FINAL Administrative Expenses Contract to Date (11.4.+11.5.-11.6.) 50,431.10 III. PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1+- 111.2: 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) If not, explain on the Remark below 50,431.10 2. FINAL Expenses Through End of Contract (11.3. + II 6.+I II.3.) 50,431.10 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES LJ/NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P/ Cush Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend ) 0.00 VII. MATCH RECONCILIATION Vax # sj I . FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + 116.+III.3.) 50,431.10 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x V11.3.) 0.00 5. Total Match Reported (VIM >or= to Match Expenditure Requirement (V11.4.)? (Check Box) YESLI /NOLI The Program Income Expense Report and Cash Request can only be extended through the availability of the Award and/or Federal funding period. /(.RtGCL[./ Date /OA Preparer's Signature Authorized Signatur 4/1/40/7 Date /O1 (tf 1 (1 See instructions for completing this form on the next page. Revised 6/1/06 Attachment H Youth Admin 4Y64.xlsx Attachment H Page I of COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT Youth Administration VAX ERF (VERF) # 4Y6500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) VAX CR# 1847 4Y65 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 0.00 2. Current Program and Admin Cash Needs (CR # , Column F) 30,320.45 3. FINAL Program and Admin Cash Needs Contract to Date (I.1.+1.2.=1.3.) 30,320.45 H. PROGRAM EXPENSE REPORT (ER) Vax 4 f: t I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (11.1.+11.2.=11.3.) ADMINISTRATIVE EXPENSE (ER) Vax 4 4Y65 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCSI23# 4 0.00 5. Current Expenses + Accruals (Through End Date of Award) 30,320.45 30,320.45 6. FINAL Administrative Expenses Contract to Date (1I.4.+11.5.=11.6.) HL PROGRAM INCOME (PI) EXPENSE REPORT Vax 4 I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ 111.2. 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) //not, explain on the Remark below 30,320.45 30,320.45 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES LJ/NOL J V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = P/ Expenses) ,..- I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - V1.2. = VI.3.) (Refund * Extend ) VIL MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. +116.-i-111.3.) 30,320.45 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (V11.2 x V11.3.) 5. Total Match Reported (V II.I.) > or = to Match Expenditure Requirement (V11.4.)? (Check Box) YESU /NOH • The Program Income Expense Report and Cash Request can only be extended through the avatiabdtty o/ the Award and/or Federal /undmg penod. fteflidItt Preparer's Signature / " aitletketti, Date /D Authorized Signatur G,�� " 1"r„'// Date /G I LEI lit Sec instructions for completing this form o e next page. Revised- 6/1/06 Attachment H Youth Admin 4Y65 xlsx Attachment H Page I of 1 COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT Youth Out of School VAX ERF (VERF) # 4Y7400000 CONTRACT or EA START DATE 07/01/14 PROGRAM INCOME START DATE END DATE 06/30/16 END DATE L CASH REQUEST (CR) VAX CR# 1847 4Y74 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 415,925.19 2. Current Program and Admin Cash Needs (CR # , Column F) 19,501.81 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.=1.3.) 435,427.00 IL PROGRAM EXPENSE REPORT (ER) Vax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (II.I.+11.2: 11.3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4Y74 u 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# # 415,925.19 5. Current Expenses + Accruals (Through End Date of Award) 19,501.81 435,427.00 6. FINAL Administrative Expenses Contract to Date (II.4.+11.5. 11.6.) IIL PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ 111.2: 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) II not, explain on the Remark below 435,427.00 435,427.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+I 11.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES L'_I/NO LJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.1. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (Vt.I - VL2. = VI.3.) (Refund * Extend ) VII. MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + II6+111.3.) 435,427.00 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x VII.3.) 5. Total Match Reported (V II.I.) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) tl YESH /NOLJ The Program Income Expense Report and Cash Request can only be extended through the ava,,noeity of the Award and/or Federal /undmg peso rcemarx: �{�^/`/_ Preparer's Signature / ' r / /\ ,4:::: / Date *//e. Authorized Signatur O21r'M Date O(4/IC See instructions for completing this for on the next page. Revised'. 6/1/06 Attachment H YOS 4Y74 xlsx Attachment H Page I of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT Youth Out of School VAX ERF (VERF) # 4Y7500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) VAX CR# 1847 4Y75 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) ',}�• _<. 0.00 2. Current Program and Admin Cash Needs (CR # , Column F) 367,447.43 3. FINAL Program and Admin Cash Needs Contract to Date (I.I.+1.2:1.3.) 367,447.43 IL PROGRAM EXPENSE REPORT (ER) Vax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (144+11.2.-31.3.) 0.00 ADMINISTRATIVE EXPENSE (ER) Vax # 4Y75 3 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# # 0.00 5. Current Expenses + Accruals (Through End Date of Award) 367,447.43 367,447.43 6. FINAL Administrative Expenses Contract to Date (11.4 +11.5. II.6.) III. PROGRAM INCOME (PI) EXPENSE REPORT Vax # ) I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 0.00 3. TOTAL PI Expenses Through End Date of Contract (111.1,+ 111.2: 111.3.) IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) If not, explain on the Remark below 367,447.43 367,447.43 2. FINAL Expenses Through End of Contract (11.3. + 116.+II1.3.) 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES LJ /NO LJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total P1 Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V.I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (PI Cash Request = PI Expenses) I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (II1.3.) 0.00 3. Total PI Cash Balance (VI.1 - V1.2. = V1.3.) (Refund * Extend ) VIL MATCH RECONCILIATION Vax 4 I. FINAL Match Reported Through End of Contract 367,447.43 2. FINAL Expenses Through End of Contract (11.3. +116.+111.3.) 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x VII.3.) 5. Total Match Reported (VII. I.) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESLI /NOD • The Program Income Expense Report and as Request can only be extended through the aveuabArty o/ the Award and/or Federal /undmg peno rxemarn. Preparer's Signature / ' (ia Date /0/04 Authorized Signatur 2.19,4aYx/ Date (#7I ti/it See instructions for completing this form on the next page. Revised. 6/1/06 Attachment H YOS 4175 xlsx Attachment H Page 1 of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 07/01/14 PROGRAM INCOME START DATE YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT Youth In School VAX ERF (VERF) # 4Y8400000 END DATE 06/30/16 END DATE L CASH REQUEST (CR) VAX CR# 1847 4Y84 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 76,031.77 2. Current Program and Admin Cash Needs (CR # , Column F) 110,579.23 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2:1.3.) 186,611.00 II. PROGRAM EXPENSE REPORT (ER) Vax # u 3 I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (11.1.+11.2.=11.3.) 0.00 ADMINISTRATIVE EXPENSE (ER) Vax # 4Y84 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# # 76,031.77 5. Current Expenses + Accruals (Through End Date of Award) 110,579.23 6, FINAL Administrative Expenses Contract to Date (II.4.+II.5: 11.6.) 186,611.00 HL PROGRAM INCOME (PI) EXPENSE REPORT Vax # t , I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ 111.2: 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense), rF 1. FINAL CR Contract to Date (1.3.) If not, explain on the Remark below 186,61 1.00 2. FINAL Expenses Through End of Contract (11.3. + II 6.+111.3.) 186,61 1.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES Ld/NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED i I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V. I. + V.2 = V.3.) 0.00 VL RECONCILIATION (P/ Cush Request = PI Expenses) k31 I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (III.3.) 0.00 3. Total PI Cash Balance (VI.1 - V1.2. = VI.3.) (Refund * Extend ) 0.00 VIL MATCH RECONCILIATION Vax # I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. + I16.+111.3.) 186,61 1.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x VII.3.) 0.00 5. Total Match Reported (VII.I.) > or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESLJ /NOLJ The Program Income Expense Report and Cash Request can only be extended through the availability of the Award and/or Federal funding period Remark: a1,// Preparer's Signature �G4�/l,i Date 41/4/4 Authorized Signatur 1, a Date /0(c1 I (t See instructions for completing this form on the next page. Revised- 6/1/06 Attachment H YIS 4Y84.xlsx Attachment H Page 1 of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 07/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 15 TITLE/PROGRAM/PROJECT Youth In School VAX ERF (VERF) # 4Y8500000 END DATE 06/30/17 END DATE L CASH REQUEST (CR) VAX CR# 1847 4Y85 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 0.00 2. Current Program and Admin Cash Needs (CR # , Column F) 59,077.82 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+1.2.-1.3.) 59,077.82 II. PROGRAM EXPENSE REPORT (ER) Vax # I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 3. FINAL Program Expenses Contract to Date (II.1.+II.2: II.3.) 0.00 ADMINISTRATIVE EXPENSE (ER) Vax # 4Y85 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS/23# # 0.00 5. Current Expenses + Accruals (Through End Date of Award) 59,077.82 59,077.82 6. FINAL Administrative Expenses Contract to Date (11.4.+II.5.=Il.6.) III. PROGRAM INCOME (PI) EXPENSE REPORT Vax 4 I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1 + III.2.= 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) .. I. FINAL CR Contract to Date (1.3.) If not, explain on the Remark below 59,077.82 59,077.82 2. FINAL Expenses Through End of Contract (II.3. + II 6.+111.3.) YES L/NOLJ 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # 1 2. Current Program Income Cash (Through End Date of Contract) (CR 4 , column G) 3. FINAL Program Income Cash Contract to Date (V. I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P/ Cash Request = PI Expensed #$ > I. FINAL Program Income Cash (V.3.) 0.00 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend ) VII. MATCH RECONCILIATION Vax 4 I. FINAL Match Reported Through End of Contract 59,077.82 2. FINAL Expenses Through End of Contract (11.3. + 116.+III.3.) 3. Match Percentage of Expenditure Contractual Requirement 0.00 4. Match Expenditure Requirement (VII.2 x VII.3.) 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) YESL /NOLJ The Program Income Expense Report and Cash Request can only be extended throu rcemar(: itfa Date / 6 �kA4 Preparer's Signature` ue /)9 / 7/ Authorized Signatur 9441,44/7 Date [ r%1 6 ri See instructions for completing this form on the next page. Revised'. 6/1/06 Attachment H VIS 4Y85.xlsx Attachment H Page I of I COLORADO DEPARTMENT OF LABOR AND EMPLOYMENT GRANT/EA CLOSEOUT RECONCILIATION WORKSHEET SUBRECIPIENT Employment Services of Weld County ADDRESS PO Box 1805 Greeley, CO 80632 CONTRACT or EA START DATE 04/01/15 PROGRAM INCOME START DATE YEAR OF FUNDS PY 14 TITLE/PROGRAM/PROJECT Youth Incentives VAX ERF (VERF) # 4YW400000 END DATE 09/30/15 END DATE L CASH REQUEST (CR) VAX CR# 1847 4YW4 I. Total Program and Admin Cash Needs Previously Reported (Last CR # 6/30/2015 ) 0.00 2. Current Program and Admin Cash Needs (CR # , Column F) 1,000.00 3. FINAL Program and Admin Cash Needs Contract to Date (1.1.+I.2.-1.3.) 1,000.00 IL PROGRAM EXPENSE REPORT (ER) Vax # sr ttri e=s st 3 I. Total Expenses + Accruals Previously Reported (Through Last Month) 0.00 2. Current Expenses + Accruals (Through End Date of Award) 0.00 3. FINAL Program Expenses Contract to Date (II.I +II.2 =II.3.) ADMINISTRATIVE EXPENSE (ER) Vax # 4YW4 to 4. Total Expenses + Accruals Previously Reported (Through Last Month) FCS123# # 0.00 5. Current Expenses + Accruals (Through End Date of Award) 1,000.00 1,000.00 6. FINAL Administrative Expenses Contract to Date (11.4 +II.5.=11.6.) HL PROGRAM INCOME (PI) EXPENSE REPORT Vax # I. Total Program Income Expenses Reported (Last Quarter) 2. Current Program Income Expenses (Through End Date of Contract) 3. TOTAL PI Expenses Through End Date of Contract (111.1.+ III.2: 111.3.) 0.00 IV. RECONCILIATION (Cash Request = Expense) I. FINAL CR Contract to Date (1.3.) II not, explain on the Remark below 1,000.00 2. FINAL Expenses Through End of Contract (11.3. + II 6+111.3.) 1,000.00 3. CR to Date = Expense reported Through End Date of Contract? (Check Appropriate Box) YES LJ/NOLJ V. CASH REQUEST PROGRAM INCOME CASH REPORTED I. Total PI Cash Previously Reported on CR (Last CR # ) 2. Current Program Income Cash (Through End Date of Contract) (CR # , column G) 3. FINAL Program Income Cash Contract to Date (V. I. + V.2 = V.3.) 0.00 VI. RECONCILIATION (P/ Cash Request = P/ Expenses)� I. FINAL Program Income Cash (V.3.) 0.00 2. Less Program Income Expenses Through Contract End Date (111.3.) 0.00 3. Total PI Cash Balance (VI.I - VI.2. = VI.3.) (Refund * Extend ) 0.00 VII. MATCH RECONCILIATION Vax 8 I. FINAL Match Reported Through End of Contract 2. FINAL Expenses Through End of Contract (11.3. +116.+111.3.) 1,000.00 3. Match Percentage of Expenditure Contractual Requirement 4. Match Expenditure Requirement (VII.2 x V11.3.) 0.00 5. Total Match Reported (VII.I.)> or = to Match Expenditure Requirement (VII.4.)? (Check Box) YES Li /NOLJ / th The Program Income Expense Report and Cash Request can only be extended through the avatlabrl#y oe Awartl and/or Fetleral /undmg penod. Preparer's Signature gM Date /O(71O Authorized Signatur 92) „.4)/ a�'%�� Date /c I 1 �"1' l i t See instructions for completing this form on the next page. Revised 6/1/06 Attachment H Youth Incentives 4YW4.xlsx Hello