City of Phoenix

City of Phoenix 2013 Neighborhood Block Watch Grant Program Quarter Report

If additional space is needed for any response, attachment pages may be utilized.

1. Applicant:

2. Project Title:

3. Grant/Contract Number: /

4. Report Covering Calendar Period From: July 1, 2013 To: September 30, 2013

1st Quarter 2nd Quarter 3rd Quarter 4th/Final Quarter

5. Progress on Goal and Objectives: In the space below, please provide information on the progress you have made this quarter to achieve the goals and objectives listed in your approved grant application.

Neighborhood Block Watch Grant Report Form Page 2

Instructions to Complete Budget Page

PROHIBITIONS: Grant funds may not be used to buy food or beverages of any kind, including consumable prizes or incentives in the form of food or beverages; motor vehicles; surveillance equipment, including night vision and listening devices; weapons of any type, including firearms, pepper spray, mace, stun guns, etc.; parties and recognition dinners; awards; entertainment, including field trips and entrance fees for in-state or out-of-state amusement and water parks; raffle prizes; bulletproof vests; overhead emergency light bars; and/or pay for administration of the grant itself.

DO NOT INCLUDE ANY PURCHASE ON THIS REPORT THAT WAS NOT REQUESTED IN YOUR ORIGINAL GRANT APPLICATION UNLESS YOU HAVE RECEIVED PRIOR APPROVAL FOR THE PURCHASE.

EXPENSE CATEGORY DEFINITIONS: When completing the budget page, please list only those categories approved for your grant budget. See your grant application budget page for categories and amounts listed.

1 – Personnel 2 – Operational Expenses 3 – Equipment/Supplies 4 – Consumables

BACK-UP INFORMATION: The quarterly report submittal must include back-up documentation for each purchase. Proper documentation includes receipts, invoices, and/or time sheets. Each month’s bank statement must also be submitted.

If your group is required to have general liability insurance or has purchased insurance with grant funds, please submit a copy of the certificate of insurance with your quarterly report.

If you have purchased an item that is $1,500 or more, please submit copies of three written bids.

FINAL REPORT NOTICE: If this is a final project report and there are funds remaining, you must return any remaining grant funds and unused interest earned to the City of Phoenix. Enclose a check or money order payable to the City of Phoenix with your final report for the amount of any remaining grant funds.

SAMPLE BUDGET AND GRANT QUESTIONS: The following page contains a completed sample budget for you to review prior to filling out your quarterly report. If you have any questions completing this page or anything else related to this report, please contact the Neighborhood Block Watch Grant staff at 602-262-6131. Neighborhood Block Watch Grant Report Form Page 3

Operational Consumable Equipment/ Personnel Beginning Approved Budget Categories: Expenses s Supplies Balance for Approved Budget Amounts: this (See Application) $2,500 $500 $3,200 $4,000 Quarter: Month/ Check VendorsDay & No.Items Vendors and Items Purchased $10,000 7/1 101 Office Max – Paper, labels $30.50 $9969.50 AlphaGraphics – Printing for Sept. 8/15 102 Newsletter $110.75 $9858.75 9/5 103 Verizon – August Cell Phone Charges $23.25 $9835.50 $ $ $ $ $ $

$ Category Expenditures This Quarter: $134 $30.50 $0 $0 SAMPLECategory Expenditures Year to Date: $134 $30.50 $0 $0 Remaining Category Balance: $2366 $469.50 $3,200 $4,000 Grant Balance After Purchases: $9835.50

BUDGET SUMMARY TO DATE Original Grant Amount: $10,000 Expenditures Prior to Current Quarter: $0 Expenditures This Quarter: $164.50 Remaining Grant Balance: $9,835.50 Neighborhood Block Watch Grant Report Form Page 4

Budget Expenditure Page Beginning Approved Budget Categories: Balance Approved Budget Amounts: for this (See Application) Quarter: Month/ Check VendorsDay & No.Items Vendors and Items Purchased $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Category Expenditures This Quarter: $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Category Expenditures Year to Date: $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Remaining Category Balance: $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Grant Balance After Purchases: $ 0.00

BUDGET SUMMARY TO DATE Original Grant Amount: Expenditures Prior to Current Quarter: $0 Expenditures This Quarter: $ 0.00 Remaining Grant Balance: $ 0.00 Neighborhood Block Watch Grant Report Form Page 5 «APPLICANT» No.

7. Objectives for the Next Quarter: Provide information on what you intend to accomplish during the next quarter (not applicable for final report).

8. Applicant’s Authorized Signatures: (two signatures required)

The undersigned certify that all information in this report is true and accurate to the best of their knowledge.

NAME (Print or Type) SIGNATURE PHONE DATE NUMBER

DO NOT WRITE BELOW THIS LINE

Deliver or mail completed reports to: City of Phoenix Police Headquarters Fiscal Management Bureau, Suite 326 620 West Washington Street Phoenix, Arizona 85003