REPLACE WITH OFFICIAL LETTERHEAD

MT DES EMPG Closeout Request Letter

(Date)

Department of Military Affairs

ATTN: DES-Delila Bruno
1956 Mt. Majo Street
PO Box 4789
Fort Harrison, MT 59636-4789

Re: 2017-2018 Emergency Management Performance Grant (EMPG) No. EMD-2017-EP-00003

(County/Tribal Name Here) Grant Closeout

Mrs. Bruno:

The above referenced grant has been successfully completed. Inspection of records, financial
monitoring and requests for reimbursement have been finalized. All funds have been expended to
the satisfaction of both the SAA and the requesting jurisdiction. The total Federal share of the grant
was $xxxxxx, in addition to the required County match of $xxxxxx. No deobligation of funds is
requested at this time. (OR) Deobligation of funds in the following amount is requested, $xxxxxx. A
Summary of Documentation, including final copies of the warrants/checks, inspection reports, etc…,
is enclosed or has already been provided through the State quarterly report system.

I hereby request closeout of this grant and certify that: the grant has been completed in accordance
with all applicable EMPG guidelines; all required and allowable funds have been equitably and
properly paid out; all reported costs were incurred in the performance of eligible work; work was
completed in compliance with the provisions of the State-Local (or “State Grantee-State Sub-
grantee” or “State-Tribal”) Agreement; grant funds were expended in accordance with the existing
requirements of Federal and State laws and regulations; no further requests for reimbursement of
this grant will be made, and that there are no further pending bills to be expended with said grant
funds. Additionally, it is understood that any inability or inconsistency to meet grant guidance
requirements by the sub recipient could result in potential corrective action, up to and including, a
reduction or loss of future grant funds, additional monitoring, or other action as determined by the
SAA.

Further, I attest that all financial records covered by this closeout request (checks, warrants,
invoices, in-kind expense reports, etc.) will be retained and made available for Inspection and Audit
per 2 CFR 200.333 (Retention requirements for records) and 2 CFR 200.500 through 2 CFR
200.507 (Audit requirements) for a period of not less than three years from closeout date or
auditable action.

After the enclosed information has been reviewed, should you require further information concerning
this project closeout, please contact (Agency Representative name) at xxx-xxxx.

Sincerely,

Agency Representative Name

(County/ Tribal) DES Coordinator (or other title if different/ desired)