Request for Capital Improvement Payment (2-16 form - North

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					Form DCC 2-16                           Department of Community Colleges                         Budget Code

College                                     Project:                                                  Date
Project Name:                                                                                                               #
To:BOARD OF COMMUNITY COLLEGES:Please draw a voucher in the amount of $__________________ for your pro rata
     share of state and/or federal funds.
To: LOCAL COUNTY: Please draw a voucher in the amount of $_______________ for your pro rata share of local funds.
                                                   (1)           (2)           (3)               (4)               (5)
  Cost                                        Total Project  Expenditures  Expenditures Unpaid Balance         Amounts Due
  Item Account Name                            Cost as Per    Paid This        To             of Total        & Unpaid Must
                                                Contract       Month          Date          Project Cost      Submit Invoice
    1 Land/Site Grading & Improv.                       0.00          0.00          0.00              0.00              0.00
    2 General Contract                                  0.00          0.00          0.00              0.00              0.00
    3 Heating Contract                                  0.00          0.00          0.00              0.00              0.00
    4 Electrical Contract                               0.00          0.00          0.00              0.00              0.00
    5 Plumbing Contract                                 0.00          0.00          0.00              0.00              0.00
    6 Architect Contract                                0.00          0.00          0.00              0.00              0.00
    7 Other Contracts                                   0.00          0.00          0.00              0.00              0.00
    8 Other Fees                                        0.00          0.00          0.00              0.00              0.00
    9 Worked Performed by Owner                         0.00          0.00          0.00              0.00              0.00
   10 Equipment (Major)                                 0.00          0.00          0.00              0.00              0.00
   11 Contingency Fund                                  0.00          0.00          0.00              0.00              0.00
   12
   13
         Total                                          0.00          0.00          0.00              0.00              0.00
                              Percent of
                             Total Project              0.00          0.00          0.00              0.00              0.00
LOCAL FUNDS(A)                 #DIV/0!                  0.00          0.00          0.00              0.00              0.00
INSTITUTIONAL FUNDS(B)              0.0000%             0.00          0.00          0.00              0.00              0.00
STATE GRANTS(C)                #DIV/0!                  0.00          0.00          0.00              0.00              0.00
                                                                STATE VOUCHER
STATUS OF STATE BD. OF COMM. COLLEGES' GRANT                           ISSUED   STATE BOARD OF COMM. COLLEGES' SHARE:
1) TOTAL GRANT(col. 1C)                                 0.00                    1) EXPENDED-TO-DATE (Col.3C)               0.00
2) EXPENDED TO DATE(col.3C)                             0.00                    2) AMT. DUE & UNPAID (Col.5C)              0.00
3) BALANCE OF GRANT                                     0.00   DATE:                 TOTAL                                 0.00
                                                                                3) LESS: AMT. REC'D-TO-DATE                0.00
We hereby certify that, to the best of our knowledge and belief, this           4) THIS REQUEST FOR FUNDS                  0.00
statement of balances and expenditures for this capital improvement is
correct, that expenditures have been made in accordance with the                               STATE LEVEL USE
statutes of North Carolina and the rules and regulations of the State
Board of Community College and that payment of this pro rata share                               Approved for Payment.
of capital improvement costs has not been received by this college.

PREPARED BY                                         DATE


PRESIDENT                                                                                        Vice-President     Date


CHIEF ADMINISTRATIVE OFFICER                DATE

        I elect to accelerate the reimbursement of 2000 (40070) bond funds (up to 97.5%) at this time.

        I elect not to accelerate the expenditure of 2000 (40070) state bond funds (up to 97.5%) at this time.
Form DCC 2-17                                                                                        DCC Project No. _______
                                       Department of Community Colleges
                                             Capital Improvement
                                          Schedule of Institutional Fund Vouchers Issued

      College:                                                                         Project #
      Column 2; 2-16                                                                       Cost
         Date      Voucher Number                          Payee                           Item                 Amount




      Must agree with Form DCC 2-16                                                    Grand Total    $                  -

      I hereby certify that the above schedule is a correct statement of all vouchers issued for this capital
      improvement project during the month(s) indicated above.

                      ____________________________________                                        ________________
                             Chief Administrative Officer                                               Date
College:                                                                         Project #
Column 5; 2-16                                                                       Cost
   Date      Voucher Number                          Payee                           Item                 Amount




Must agree with Form DCC 2-16                                                    Grand Total    $                  -

I hereby certify that the above schedule is a correct statement of all vouchers issued for this capital
improvement project during the month(s) indicated above.

                ____________________________________                                        ________________
                       Chief Administrative Officer                                               Date