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�r <br /> ` ► <br /> FISCAL INFORMATION SHEET <br /> The following information is required to ensure that the Authority and its implementing agencies <br /> meet the financial and program reporting requirements of various federal grant programs. This <br /> information is required prior to the release of funds. The Implementing Agency is the state or local <br /> unit of government or not-for-profit agency accepting funds under the interagency agreement. The <br /> Program Agency is the organization responsible for performing the daily activities. An organization <br /> can be both the Implementing Agency and the Program Agency. <br /> Please return this form to the attention of your program monitor at the Illinois Criminal Justice <br /> Infortnation Authority, Federal and State Grants Unit, 120 S. Riverside Plaza, Chicago, IL <br /> 60606. If you have any questions, please call your monitor at(312) 793-8550. <br /> Implementing Agency: City of Decatur - Decatur Police Department <br /> Implementing Agency's FEIN#: 37-6001308 Agreement#: 107026 <br /> PTOgTam AgenCy: Decatur Police Department <br /> Program Title: Project Safe Neighborhoods - Anti-Crime Team <br /> 1. Who will be responsible for preparing and submitting quarterly fiscal reports? <br /> Na111e: James R. Chervinko <br /> Tltle: Deputy Chief of POlice <br /> 1�geriCy: Decatur Police Department <br /> Address: 333 s. Franklin Street, Decatur, Illinois 62523 <br /> Phone: (217) 424-2768 F�: (217) 424-2766 <br /> 2. Who will be responsible for preparing and submitting quarterly data/progress reports? <br /> Name: James R. Chervinko <br /> Tltl�: Deputy Chief of Police <br /> AgenCy: Decatur Police Department <br /> Address: 333 s. Franklin Street, Decatur, Illinois 62523 <br /> Phone: �217) 424-2768 Fax: (217) 424-2766 <br /> P:�FORMS\Initiation\Fiscal Information Sheet 04.03.doc <br />