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City of Oakland
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Department of Human Services—Fiscal Services
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Request for Funds
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 ( X ) Advance
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( ) Cash Drawdown
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( ) Reimbursement
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Requisition No.:1-Advance
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Period Ending:9/30/21
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Contractor Payee:
Tiny Logic Date Submitted:10/8/21
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Budget Cost CategoryApproved BudgetCurrent Amount RequestedTotal Prior PaymentsTotal Payments to DateUnexpended Budget Balance
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Advance$350,000.00 $105,000.00 $105,000.00 $245,000.00
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Total$350,000.00 $105,000.00 $0.00 $105,000.00 $245,000.00
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Contractor:I certify that the information contained in this request is correct and that the expenditures herein supported by attached payrolls, invoices, and proof of payment, were made in accordance with the conditions of the contract.
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Approved By/Title/Date:
Adam Garrett-Clark, Principal,
10/8/2021
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The above contractor has met the programmatic terms and conditions set forth in the contract for the month of _______advamce - July_________, 2021___, Payment in the amount of $ _____37,499.85____________ is hereby authorized.
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DHSTITLEDATE
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