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City of Santa Ana <br />Request for 2nd Disbursement <br />Safely Home in Santa Ana Eviction Prevention Program <br />Organization: The Salvation Army of Orange County <br />Program Name: Safely Home in Santa Ana <br />Mailing Address for Check: <br />a ance <br />Available <br />Prior to 2nd <br />Total <br />Disbursement <br />2nd <br />Amount <br />Initial <br />Request <br />Disbursement <br />Budget Category <br />Approved <br />Disbursement <br />($7,500 cr under) <br />Request <br />Rental Assistance <br />$ 45,000.00 <br />$ 22,500.00 <br />$ 22,500.00 <br />Indirect Cost 10% <br />$ 5,000.00 <br />$ 2,500.00 <br />$ - <br />$ 2,500.00 <br />Date <br />1 10/1 /2019 <br />Totals <br />1 $ 93,739.00 <br />1 $ 25,000.00 <br />1 $ - <br />$ 25,000.00 <br />I certify that the Information provided an this request Is correct and that expenditures reflected hereon are made in accordance <br />with the conditions of the Agreement. I have also attached all backup documents (XXXXX) <br />as necessary to reflect this disbursement. <br />Print Name $ Title <br />Vendor Number <br />Agreement Number <br />Invoice Number <br />Date Received <br />AU/AC <br />Approved <br />Date Approved <br />Quarter 1 <br />