Reimbursable Agreement Data Form

ADVERTISEMENT

G
INITIAL SUBMISSION
G
FOR MODIFICATION __________
REIMBURSABLE AGREEMENT DATA FORM 3-2058
PROJECT TITLE: _Fish Health Services_____________________________________________________________
( NON - FEDERAL)
CUSTOMER NAME: __Illinois Department of Natural Resources_________________________________________________________
TIN: E9984113403
AGREEMENT NO. -USFWS: __FWS 1448-30141-8-J093___________________________________________________
RESPONSIBLE
( DIFFERENT THAN DEFAULT)
ARD COST
CUSTOMER REFERENCE NO.: __chk#AC110301_____________________
: ____________________________
STRUCTURE
THIS 3-2058 IS FOR
FY- 2002___________ ,
PERFORMING ORG. CODE: __32141___________________________
SUBACTIVITY:
1937
PROJECT:
0001
START OF WORK DATE: _10/01/98___________________
PLANNED COMPLETION DATE: __09/30/2003______________________
LESS
TOTAL AMOUNT AUTHORIZED IN THIS AGREEMENT:
$
5,000.00
$ _____________________
BURDEN
TARGET
AMOUNT AUTHORIZED FOR CURRENT FY (2001):
$ _
1,300.00____________________
AMOUNT
USFWS PROJECT MANAGER
Richard C. Nelson, Project Leader BILLING CONTACT Larry Dunham, Division of Fisheries
ADDRESS
_555 Lester Ave-Suite 100
________ Illinois Department of Natural Resources__
nd
Lincoln Tower Plaza, 524 So. 2
Street
CITY / STATE / ZIP
Onalaska, WI 54650
Springfield, IL 62701-1787
PHONE
( 608 ) 783-8444
(217 )785-8268
BILLING INFORMATION FOR FINANCE CENTER
APPLICABLE ADMINISTRATIVE SUPPORT RATE IS ____________%. IF APPLICABLE, APPROVED EXCEPTION TO POLICY IS
1
ATTACHED. OTHERWISE, THE STANDARD OVERHEAD RATE IS _______%
.
RATE DESCRIPTION: _________/_______________________
THE AGREEMENT IS MODIFIED EFFECTIVE ________________________ BY MODIFICATION NO. __________________
TO: INCREASE ____ DECREASE ____ THE AMOUNT BY $ ________________________
______________________
CHANGE THE: ____ START OF WORK DATE (OR) THE ____ PLANNED COMPLETION DATE TO
SIGNATURE OF USFWS OFFICIAL
_______________________________________
TITLE
_______________________________________
DATE
_______________________________________
CONCUR: ___________________________________________________
Revised 10/00
REGIONAL FINANCE OFFICER
1
In accordance with Part 264, Chapters 1 & 2 of the U.S. Fish & Wildlife Service Manual- the standard overhead rate is calculated
through a biennial review process conducted by the Divisions of Budget and Finance. Contact your Regional Budget & Finance office for the
current rate.

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2