Sheet 1: Invoice 

	
	
	
	
	
	
	
	
	
	
	
	
	
	
	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
STATE OF CALIFORNIA
		


		


		


		


		


		


		


		


		


		
JUDICIAL COUNCIL OF CALIFORNIA
		


		


		


		


	
	

		


		
JC-1-INVOICE (REV 08-21)
		


		


		
INVOICE
		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		
SEND TO:
		


		
GRANT ACCOUNTING
		


		


		


		


	
	

		


		


		


		


		


		


		


		


		
455 GOLDEN GATE AVENUE, 6th FLOOR
		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		
SAN FRANCISCO, CA 94102
		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		
AB1058.Invoice@jud.ca.gov
		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
		


		


		


		


		


		
CONTRACT NUMBER:
		


		


		


		


	
	

		


		
 
		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
ADDRESS:
		


		


		


		
BILLING PERIOD:
		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
PROGRAM TITLE:
		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
PROGRAM PERIOD:
		


		


		
JULY 1, 2021 TO JUNE 30, 2022
		
FISCAL YEAR
		
2021-22
		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
ACCOUNTING CONTACT:
		


		


		


		


		


		


		
PHONE NUMBER:
		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
E-MAIL ADDRESS:
		


		


		


		


		


		


		
FAX NUMBER:
		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
PROGRAM EXPENDITURES (FUND REQUESTED)
		


	
	

		


		
CATEGORY
		
AMOUNT
		
	

		


		
PERSONNEL (Salaries & Benefits)
		


		
	

		


		
OPERATING EXPENSES & EQUIPMENT
		


		
	

		


		
INDIRECT COSTS
		


		
	

		


		
TOTAL EXPENDITURES
		
 -   
		
	

		


		
TOTAL REIMBURSABLE AMOUNT
		


		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
CERTIFICATION:
		


		
I HEREBY CERTIFY UNDER PENALTY OF PERJURY THAT THE AMOUNT BILLED ABOVE IS TRUE AND CORRECT IN 
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		
ACCORDANCE WITH THE CONTRACT.
		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
COURT OFFICIAL (NAME & TITLE) : 
		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
SIGNATURE:
		


		


		


		


		


		
DATE
		


		


		


	
	

		


		


		


		
ERROR: INPUT PROGRAM TITLE ABOVE
		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
(This document may be signed using an electronic signature, as defined in CRC, rule 2.257(a). By typing your name into the signature
 line and entering the date, you are attesting to signing this document under the penalty of perjury under CRC, rule 2.257(b).)
		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
FOR JC GRANT ACCOUNTING USE ONLY
		
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
REC'D:
		


		


		
PROGRAM:
		


		


		


		


		


		
CONTRACT NO.:
		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		
INVOICE DATE:
		


		


		
INVOICE NO.:
		


		


		


		


		


		
AMOUNT: $
		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		
PROGRAM MANAGER APPROVAL
		


		


		


		


		


		


		


		
DATE
		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


		


	



Sheet 2: Invoice Instructions

	
	
	

		
STATE OF CALIFORNIA
		


	
	

		
JC-1-II (REV 08-21)
		
FAMILY LAW FACILITATOR PROGRAM
	
	

		


		


	
	

		


		
INVOICE INSTRUCTIONS
	
	

		


		
CHILD SUPPORT COMMISSIONER PROGRAM
	
	

		


		
FAMILY LAW FACILITATOR PROGRAM
	
	

		
Original signed invoice is required to process a claim for payment (use blue ink). Do not add or delete any item or category. ALTERED FORMS WILL NOT BE USED FOR PROCESSING CLAIMS FOR PAYMENTS. 

Do not highlight, write any notes, comments, instructions, journal entry numbers, accounts receivable numbers, or Phoenix accounting coding numbers (WBS numbers).  The SCO scan the invoice for issuing warrant and does not accept invoice with notes, comments, instructions, journal entry numbers, accounts receivable numbers, WBS numbers, or other numbers- for issuing payments.
		
	

		


		


	
	

		
SUPERIOR COURT OF CALIFORNIA, COUNTY OF:
		
Enter county name.
	
	

		


		


	
	

		
ADDRESS:
		
Enter court address where the payment is to be sent. 
	
	

		


		


	
	

		
CONTRACT NUMBER:
		
Enter grant contract number as it appears on the contract. 
	
	

		


		


	
	

		
BILLING PERIOD:
		
Enter month and year.
	
	

		


		


	
	

		
PROGRAM TITLE:
		
Select the program title from the dropdown list.
	
	

		


		


	
	

		
PROGRAM PERIOD:
		
July 1, 2021 through June 30, 2022.
	
	

		


		


	
	

		
FISCAL YEAR:
		
2021-22
	
	

		


		


	
	

		
COURT ACCOUNTING CONTACT:
		
Enter court accounting contact person's name who will be able to answer billing questions. 
	
	

		


		


	
	

		
PHONE NUMBER:
		
Enter court accounting contact person's phone number. 
	
	

		


		


	
	

		
EMAIL ADDRESS:
		
Enter court accounting contact person's e-mail address. 
	
	

		


		


	
	

		
FAX NUMBER:
		
Enter court accounting contact person's fax number. 
	
	

		


		


	
	

		
PERSONNEL:
		
Enter total costs of court employees payroll expenses (salary and benefits) claimed for this billing period. This amount should match the amount reflects on the summary sheet which is the total of total program salary and benefits.
	
	

		


		


	
	

		
OPERATING EXPENSES & EQUIPMENT:
		
Enter the operating expenses claimed for this billing period. This should match the amount reflected on the summary sheet which matches the expenses reported on the operating expense recap sheet.  
	
	

		


		


	
	

		
INDIRECT COSTS:
		
Enter indirect costs claimed for this billing period. 
	
	

		


		


	
	

		
TOTAL EXPENDITURES:
		
Enter total of all items above (personnel, operating expenses, and indirect costs). 
	
	

		


		


	
	

		
TOTAL REIMBURSABLE AMOUNT: 
		
Enter the total amount to be reimbursed to court. This amount should match the calculated amount of base and federal drawdown option funds reflected on the Summary Sheet. 
	
	

		


		


	
	

		
CERTIFICATION:
		
The invoice includes the following required certification: “I hereby certify under penalty of perjury that the amount billed above is true and correct in accordance with the contract." This certification may not be removed or modified.
	
	

		


		


	
	

		
COURT OFFICIAL NAME AND TITLE:
		
Enter court official's name and title who is authorized to sign the invoice. 
	
	

		


		


	
	

		
SIGNATURE:
		
Authorized court official's signature.
	
	

		


		


	
	

		
DATE:
		
Enter the date the invoice is signed.  
	



Sheet 3: Summary Sheet

	
	
	
	
	
	
	
	

		
STATE OF CALIFORNIA
		


		


		


		


		


		


	
	

		
JC-2-SUMMARY SHEET (REV 08-21)
		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		
JUDICIAL COUNCIL OF CALIFORNIA
		
	

		
SUMMARY SHEET
		
	

		


		


		


		


		


		


		


	
	

		
COURT NAME:
		


		


		


	
	

		


		


		


		


		


		


		


	
	

		
PROGRAM TITLE:
		


		


		


	
	

		


		


		


		


		


		


		


	
	

		
FISCAL YEAR:
		
2021-22
		
REPORTING PERIOD:
		


		
	

		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		


		


		


		


		


		


		


	
	

		
A
		
B
		
C
		
D
		
E
		
F
	
	

		
CATEGORY
		
BUDGET
		
PREVIOUSLY
BILLED
		
CURRENT
EXPENDITURE
		
YTD
EXPENDITURE
		
BALANCE
	
	

		
SALARIES
		


		


		


		
 -   
		
 -   
	
	

		
BENEFITS
		


		


		


		
 -   
		
 -   
	
	

		
UNFUNDED CalPERS PREMIUM
		


		


		


		


		


		


	
	

		
WORKERS' COMPENSATION
		


		


		


		


		


		


	
	

		
TOTAL PERSONNEL EXPENSE
		
 -   
		
 -   
		
 -   
		
 -   
		
 -   
	
	

		


		


		


		


		


		


		


	
	

		
INDIRECT COSTS
		
20.00%
		
 -   
		
 -   
		
 -   
		
 -   
		
 -   
	
	

		
INDIRECT COSTS ADJUSTMENT
		


		


		


		


		
 -   
		
 -   
	
	

		
TOTAL INDIRECT COSTS
		


		
 -   
		
 -   
		
 -   
		
 -   
		
 -   
	
	

		


		


		


		


		


		


		


	
	

		
OPERATING EXPENSES
		


		


		


		


		


	
	

		
CONTRACT FACILITATOR
		


		


		


		
 -   
		
 -   
	
	

		
CONTRACT COURT REPORTER
		


		


		


		
 -   
		
 -   
	
	

		
CONTRACT INTERPRETER
		


		


		


		
 -   
		
 -   
	
	

		
OTHER CONRACT
		


		


		


		


		
 -   
		
 -   
	
	

		
SUBTOTAL 
		


		
 -   
		
 -   
		
 -   
		
 -   
		
 -   
	
	

		


		


		


		


		


		


		


	
	

		
COUNTY SERVICES
		


		


		


		
 -   
		
 -   
	
	

		
OFFICE SUPPLIES
		


		


		


		
 -   
		
 -   
	
	

		
TRAVEL/TRAINING/REGISTRATION
		


		


		


		
 -   
		
 -   
	
	

		
EQUIPMENT RENTAL/LEASE
		


		


		


		
 -   
		
 -   
	
	

		
IT REPAIR/MAINTENANCE
		


		


		


		
 -   
		
 -   
	
	

		
RENT/STORAGE
		


		


		


		
 -   
		
 -   
	
	

		
SECURITY: PERIMETER
		


		


		


		
 -   
		
 -   
	
	

		
SECURITY: BAILIFF
		


		


		


		
 -   
		
 -   
	
	

		
OPERATING EXPENSE % RATE ADJUSTMENT
		


		


		


		


		


		


	
	

		
SUBTOTAL
		


		
 -   
		
 -   
		
 -   
		
 -   
		
 -   
	
	

		


		


		


		


		


		


		


	
	

		
TOTAL OPERATING EXPENSES
		
 -   
		
 -   
		
 -   
		
 -   
		
 -   
	
	

		


		


		


		


		


		


		
 -   
	
	

		
TOTALS
		
 -   
		
 -   
		
 -   
		
 -   
		
 -   
	
	

		


		


		


		


		


		


		


	
	

		
G
		
H
		
I
		
J
		
K
		
 L 
	
	

		
FUNDING SOURCES
		
GRANT
AMOUNT
		
PRIOR REIMBURSEMENT
		
BALANCE PRIOR TO CURRENT REIMBURSEMENT
		
CURRENT  REIMBURSEMENT
		
 GRANT BALANCE 
	
	

		
BASE AWARD
		
100%
		


		
 -   
		
 -   
		
 -   
		
 -   
	
	

		
FEDERAL DRAWDOWN
		
100%
		


		
 -   
		
 -   
		
 -   
		
 -   
	
	

		
FEDERAL SHARE
		
66%
		
 - 
		
 -   
		
 -   
		
 -   
		
 -   
	
	

		
COURT SHARE
		
34%
		
 - 
		
 -   
		
 -   
		
 -   
		
 -   
	
	

		
TOTAL REIMBURSEMENT
		


		
 - 
		
 -   
		
 -   
		
 -   
		
 -