Checklist for Interim Disbursement 5C 05-16

OMB Number: 0610-0096
Expiration Date: 11/30/2021

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ECONOMIC DEVELOPMENT ADMINISTRATION
CHECKLIST FOR INTERIM DISBURSEMENT
EDA Award Number:

Date:

Recipient:
Co-Recipient(s):
Recipient’s Authorized Representative:
Name & Phone Number

Y

The interim disbursement amount request is $
1. The Special Award Conditions requiring action prior to disbursement have been satisfied.
2. A complete and signed Form SF-271 for Pay Request Number
submitted to EDA.

has been

3. All partial pay estimates and invoices have been listed on the project EDA Financial
Spreadsheet and the spreadsheet has been submitted to EDA.
4. Copies of the partial pay estimates and invoices supporting the claim for
reimbursement has been submitted to EDA.
5. The current quarterly progress report has been submitted to and accepted by EDA.
6. The current semi-annually Federal Financial Report (SF-425) has been submitted to and
accepted by EDA.
7. Copies of the weekly certified payrolls are on file and are available to the Government
upon request.
8. The project/grant administrator has certified that all contractors and subcontractors have
complied with Davis-Bacon wage rate requirements.
9. Matching funds for the Recipient’s share are on hand or immediately available.
10. All work accomplished by change order that is part of the claim for disbursement has
been approved by EDA.
11. All proposed or actual changes to the EDA-approved budget have been approved by EDA

Prepared By (Signature)

Date

Prepared By (Typed or Written Name & Title)
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N

NA