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<br />.. <br /> <br />. <br /> <br />t · ' __ <br /> <br />Appendix C -- Form of Reimbursement Request <br /> <br />REIMBURSEMENT REQUEST <br /> <br />,2009 <br /> <br />UASI Management Team <br />10 Lombard Street, Suite 410 <br />San Francisco, CA 94111 <br /> <br />Re: FY 08 UASI Grant Reimbursement Request <br /> <br />Pursuant to Section 3.9 of the Agreement Between the City and County of San Francisco and <br />the County of Redwood City for the Distribution of FY 2008 UASI Regional Funds (the <br />"Agreement"), dated October 23, 2008, between the County of Redwood City ("REDWOOD <br />CITY") and the City and County of San Francisco, REDWOOD CITY hereby requests <br />reimbursement as follows: <br /> <br />Total Amount of <br />Reimbursement <br />Requested in this $ <br />Request: <br /> <br />Maximum Amount of <br />Funds Specified in <br />Section 3.2 of the <br />Agreement: $ <br /> <br />Total of All Funds <br />Disbursed Prior to this <br />Request: $ <br /> <br />REDWOOD CITY certifies that: <br /> <br />(a) The total amount of funds requested pursuant to this Funding Request will be used <br />to reimburse REDWOOD CITY for Authorized Expenditures, which expenditures <br />are set forth on the attached Schedule 1, to which are attached true and correct <br />copies of all required documentation of such expenditures. <br /> <br />UASI FY08 - Redwood City <br /> <br />C-1 <br />