135x Filetype XLSX File size 0.30 MB Source: www.courts.ca.gov
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).) |
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FOR JC GRANT ACCOUNTING USE ONLY | |||||||||||||||
REC'D: | PROGRAM: | CONTRACT NO.: | |||||||||||||
INVOICE DATE: | INVOICE NO.: | AMOUNT: $ | |||||||||||||
PROGRAM MANAGER APPROVAL | DATE | ||||||||||||||
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. |
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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. |
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 | - | - | - | - | - |
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