PROJECT(1): insert name of project here
DEQ Contract No.(2): insert contract # here
Billing Period(3): insert date range here Statement Date(4): insert stmt date here
Goal/Objective/Task *DEQ Current Yr-to-Date Balance non-Federal Federal
(as listed in Attachment A)(5) Grant (6) Billing (7) Expended (8) Remaining (9) Match Required Match required
ADMINISTRATIVE FEE : $ -
ADVANCE : $ -
TOTALS $ - $ - $ - $ -
Total This Billing Cycle $ - $ -
*List total DEQ grant amount for that goal/objective/task and the DEQ grant amount for the current State Fiscal year
Comments Section :
I certify the above costs are actual, necessary and allowable for the performance of the agreement. There are no duplicate costs and the statement
is mathematically correct. All progress reports required under this contract are current.
If you need a copy of this revised billing statement sent to you on computer disk, please call __________________ @ (406) 444-XXXX
EXHIBIT IV - Page 2
MATCH REPORTING SHEET
PROJECT(1): insert name of project here These are automatic fill
EPA Grant: insert grant# 0 based on "Billing
Billing Period(3): insert date range here #VALUE! Statement"
Non-Fed Match (15) Federal Match Description(18)
Goal/Objective/Task In-Kind Match* In-Kind Match* Match Source (Please Specify)
Totals: $ - $ -
* See Instructions Tab for further Explanation
Exnibit IV - Instructions
Billing Statement Tab
1) Project: List the Project Name (Example: “The XYZ Restoration Project”)
2) DEQ Contract No: List the DEQ Contract number listed in the upper right hand of the Contract Agreement. (Example: (DEQ
Contract No.: 202040)
3) Billing Period: List the period that work has been completed. (Example: Quarterly 4/1/01-6/30/01) or monthly (4/1/01-4/30/01)
4) Statement Date: List the date submitted.
5) Goal/Objective/Task: This is from the PIP, which is Attachment A within the contract. This column will be completed by DEQ.
(Example: List all Goals, Objectives, and Tasks, (Goal 3.2, Obj. 1.A,Task 1)
6) DEQ Grant: This is total contract amount, which will be completed by DEQ.
7) Current Billing: List your current billing amount for the time period for each task. This column total is formula driven.
8) Yr-to-date Expended: This column is an accumulation of monies spent on your contract. You will need to calculate this
accumulation by adding the amount in your previous billing statement Yr-to-Date column to the current billing column.
9) Balance Remaining: This column is a running balance of monies remaining in your contract. This column is formula driven.
10) Administrative Fee: This is an item in the task column. Make sure you record your Admin. Fee on each billing statement.
11) Advance: This row is to record any Advance of monies sent to you. You will need to account for your advance as you go, or at
the end of your contract. (Common practice is to account for your advance at the end of the contract).
*** Expensing an Advance-Example: At the beginning of your contract you ask for an advance of $7,250. At the closing of your
contract, you would submit to DEQ your Attachment B listing your current charges, which needs to equal the balance left in your
contract and any match. If Attachment B equals the $7,250 you would not be receiving a check but would be accounting for the
monies you had already received from DEQ. If the Attachment B exceeds that amount, we would account for the $7,250 and cut you
a check for the difference. The comment line at the bottom of your Attachment B can be used to give us instructions on how to
expense out the advance by writing “Please post against advance”.
12) Comments Section: Note here any information pertaining to the billing statement.
13) Date and Sign the Attachment B: If the Attachment B is submitted unsigned, it will be returned to the sender, which will slow
down the payment process. DEQ’s Central Service Division requires original signatures.
14) Double-Check: The totals on all your columns are formula driven. Double check all information you have entered is correct and
it balances across and down on the statement.
Match Reporting Sheet Tab
15) MATCH Non-Fed: Non-Federal match includes salaries or funds from state, local, private or in-kind (see below).
In-kind Match: All in-kind contributions must be necessary for the completion of the project and verifiable from the recipient’s
records. Some examples are as follows:
· Volunteer Services – time provided by non-federal funds by qualified person and valued consistently with those paid for similar
· Facilities – office space, classrooms, warehouses, land (value to be established).
· Materials – office, maintenance, workshop, classroom supplies (must not exceed fair market value at time it is donated to the
· Equipment – office machines
· BIA – 638 funds
· Personal Services – furnished by professional and technical personnel, consultants, labor other than staff of recipient.
· Non-cash Donations – cannot claim equipment and real property if property donated to recipient by Federal Government or
purchased with Federal funds.
· Other – Work with your Grants Office on any other charges.
16) MATCH Federal: Federal match includes funding from any federal sources. It would include federal salaries or matching funds
from other federal grants or programs.
*** The easiest way to keep the two straight is to trace the source of money. One common mistake is to include the Natural
Resource and Conservation Service (NRCS) as non-federal match. State or local employees’ salaries that come from a federal grant
or payroll are not eligible as non-federal match. DEQ nonpoint source program staff are Federally funded, for example, so their
assistance on projects cannot count as state match.
17)Source of Federal Match: Name of federal agency providing federal match listed in the prior column.
18) Description: description of what constitutes listed match. Examples include: secretarial assistance including hours worked,
database work, project reviews, etc.