Offshore Wind Business Program Milestone 1

Maryland Offshore Wind Capex Program - FY 2022

Milestone 1 - Groundbreaking Invoice Submission Form
Reporting Information
PLEASE NOTE: Your participation in this grant program requires you, the Grantee, to submit this invoice after the completion of a project milestone.

Failure to submit a properly completed milestone invoice may result in a significant delay in your financial reimbursements.
Acknowledgement *

I understand

Part 1 - Milestone Checklist

Milestone Invoice Required Materials Checklist
Please verify that you have the documents listed below ready for upload on Part 4 of this form. MEA will require the documents for each item listed below if applicable to your project scope of work.

If you have any questions regarding the requirements, please contact Emma Stoney, MEA Wind and Water Program Manager at wind.mea@maryland.gov or (410) 382-1605

NOTE: This form must be submitted with an invoice from the Grantee. The invoice should be on the Grantee’s letterhead or standard invoicing document.
Required Materials Checklist

Part 2 - Grantee Information
Organization (Grantee) Name *
Organization (Grantee) Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Federal Tax ID Number *
Project Information
Project Name (if applicable) *
Milestone 1 Completion Date *

Month Day Year
Date
Project Address (if different from above)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Jurisdiction Where Work is Occurring *
Maryland County or Baltimore City.
Maryland Legislative District Where Work is Occurring *
Congressional District Where Work is Occurring *
If you do not know your Maryland Legislative or Congressional District, please look up on www.mdelect.net.
Grantee Point of Contact Information
Authorized Representative Name *

First Name Last Name
Authorized Representative Title *
Authorized Representative Work Address (if different from above)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Authorized Representative Email *
example@example.com
Authorized Representative Phone Number *

Area Code Phone Number
Authorized Representative Mobile Phone Number *

Area Code Phone Number

Part 3 - Grantee Invoice
MEA Grant Number *
Your MEA Grant number can be found on your Grant Agreement. It is in the header on the right of each page.
Grantee Invoice Number *
Total Grant Award Amount *
Total Reimbursement Request *
Please refer to your Grant Agreement for the specified Milestone amounts
Grant Funds Remaining *

Part 4 - Supporting Documents
Attachment D Milestone Reporting Spreadsheet *

Browse Files
For Grantee reimbursement, grantees must submit Attachment D, titled Milestone Reports as part of their original grant package issued by MEA. This document is also available on the Program webpage in the section titled "Reporting and Invoicing for Existing Grantees." The Milestone Reporting spreadsheet consists of a Summary of Work, Proof of Completion, and Milestone invoice. Cancel of
Invoice(s) Paid by Grantee *

Browse Files
Copy of all invoices issued to Grantee which detail products or services purchased. Please provide proof of payment if invoices do not indicate a zero balance. Cancel of
Photos of Work Completed

Browse Files
Grantee must provide photos of work completed during the Milestone. Photos of Work completed may include but is not limited to, photographs of construction phases, finalized design and/or technical drawings, manufacturer cut and/or data sheets, inspections, and copies of permits acquired by the authority having jurisdiction (AHJ) If the file size is too large, pictures may be emailed to the MEA Program Manager. Cancel of
Additional Documents

Browse Files
Upload as many additional documents as desired. Cancel of

Submit
I certify the information provided in this submission and all of its attachments are complete, accurate, and true. In addition, I am authorized to provide MEA with this submission on behalf of the Grantee. *

I Agree
Please sign your name using your mouse. *

Clear
Printed Name *

First Name Last Name
Date *

Month Day Year
Date Hour Minutes AM/PM Option
Should be Empty:

Maryland Offshore Wind Capex Program - FY 2022