Common use of MONITORING INFORMATION REQUIREMENTS Clause in Contracts

MONITORING INFORMATION REQUIREMENTS. Please confirm that a twenty-four month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this payment request form. Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code

MONITORING INFORMATION REQUIREMENTS. Please confirm that a twenty-four twelve month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this payment request form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code

MONITORING INFORMATION REQUIREMENTS. Please confirm that a twenty-four twelve month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this payment request form. Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code

MONITORING INFORMATION REQUIREMENTS. Please confirm that a twenty-four six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this payment request form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier codecode 4891 X012 J001 SG15017

MONITORING INFORMATION REQUIREMENTS. Please confirm that a twenty-four twelve month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this payment request form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code

MONITORING INFORMATION REQUIREMENTS. Please confirm that a twenty-four six month monitoring report against key deliverables, as agreed in the Grant Agreement, has been attached to this payment request form. ☐ Please complete the below table in order to provide a breakdown of expenditure, and attach the detailed supporting financial information to this payment request form. The Commissioner may request the recipient to clarify any information provided. Breakdown of expenditure (items) £ Direct Staff costs (including oncosts) Travel Supplies and Services Management Overhead Other (provide detail) Total: CONFIRMATION BY GRANT RECIPIENT I confirm that on the basis of the information provided in this report, progress and costs are accurate and in compliance with the terms and conditions of the Grant Agreement: Signature: Name (printed): Date: Position: Office of the Police and Crime Commissioner for Derbyshire sign off: Signature: Name (printed): Date: Position: OPCC codes: Account Code Cost Centre Project code Project Reference Supplier code