GRANTEE'S NAME
PROJECT TITLE
AWARD AMOUNT PROJECT NUMBER
DMV PROJECT MONITOR'S NAME
Training/Travel
Salaries/Wages
EXPENDITURES
ORGANIZATION'S MATCHING
DOLLARS
Indirect Costs
(facilities and administrative)
Media
Totals
Fringe Benefits
Contract Costs
Other Direct Costs
Equipment
TYPE OF MATCH
(cash or in-kind service)
EXPENDITURE CATEGORY
GRANT FUNDS
EXPENDED
DMV TRANSPORTATION SAFETY GRANTS
TOTAL COST AND MATCHING REPORT
TSS 20 (03/10/2020)
GRANT INFORMATION
REPORTING QUARTER (mm/dd/yyyy - mm/dd/yyyy)
CERTIFICATION
I certify and affirm that all information presented in this section is true and correct, that any documents I have presented to DMV are genuine,
and that the information included in all supporting documentation is true and accurate. I make this certification and affirmation under penalty
of perjury and I understand that knowingly making a false statement or representation on this form is a criminal violation.
PROJECT DIRECTOR'S SIGNATURE
DATE (mm/dd/yyyy)
PROJECT DIRECTOR'S NAME (print)
Purpose: Use this form to identify and track the required monetary and/or in-kind services match related to the total
project costs.
Instructions: Complete all applicable categories in ink or type and sign. This report must be filed quarterly and
supporting documentation must accompany this report. Please mail to Grants Management Office, 2300
West Broad Street, Richmond, Va. 23269.
PROJECT DIRECTOR'S NAME
