CASS ATTACHMENT A.PDF

Maricopa County Human Services Department Contract #: C-22-14-026-3-00 Attachment A
Central Arizona Shelter Services (CASS) Payment Request and Requirements
Contract Budget Amount of New Total New Balance in
Amount Request Requested YTD Budget
Cash Flow Payment Component for Emergency Shelter & MOS $750,000.00
Provided to
Requirements:
MCHSD:
1. Summary Monthly Financial Report for Emergency Shelter and MOS
2. Monthly Occupancy Information Report
3. HMIS Progress/Program Performance reports by month
Performance Payment Component
Provided to
Requirements:
MCHSD:
PAYMENT #___ TOTAL
CASS Authorized Signature: Title: Date:
MCHSD/CDD Signatures: Contract Administrator: Date:
Assistant Director: Date:
Program Accountant: Date: