Washington Trust for Historic Preservation — Third Places Grant Completion Report

General Information

Grant Completion Reports must be submitted at the conclusion of the project or project phase prior to receiving the grant award as a reimbursement. Staff will review your completion report and reach out if we have any questions or if anything is missing. Reimbursement may take 2-4 weeks to process.

Please contact grants@nullpreservewa.org or call (206) 462-2999 if you have any questions.

Grant Contract #*

Found on your grant contract

Full Grant Award Amount*

Found on your grant contract

Reimbursement Request*

Typically, the full grant award amount – but you can request up to 3 partial reimbursements.

Are you returning unused award funds?*

Yes, I am forfeiting the remaining amount to the program fund.
No, I used and requested reimbursement of the full grant amount.

Reimbursement Number*

First Partial Reimbursement
Second Partial Reimbursement
Final Reimbursement (Project Closeout)

How would you like to be reimbursed?*

DAHP sends a check in the mail
DAHP issues a direct deposit (must provide valid Statewide Vendor (SWV) number)

Project & Grantee Information

Name of the historic building or site of the project*

County*

Grantee Name*

First Last

Grantee Organization (if on contract)

Grantee Organization EIN/Tax ID/Federal ID for reimbursement

Grantee Organization Statewide Vender (SWV) number (if applicable, for direct deposit):

Email*

Phone*

Mailing Address (where check will be mailed to, if not direct deposit)*

Street Address City State ZIP Code

Project Information

Project beginning date*

Approximation of first working day

Project completion date*

Approximation of last working day

Project Results*

Describe the project as complete and any notable impacts it had and how the funding was useful for the project and community.

Changes Scope of Work (if any)*

Describe any changes from the originally approved scope of work, including but not limited to time, cost, materials, or methods.

Historic Preservation Workforce*

Provide the number of PAID jobs created from this project. In other words, how many different people worked on the project. If possible, please include a breakdown of jobs created according to work elements or roles (eg. 1 lead contractor, 4 on foundation, and 4 others on the roof).

Volunteer Labor

Please also indicate the number of people or hours of VOLUNTEER or DONATED labor used, if any (eg. 2 board members and 2 volunteers spent 3 hours each clearing the building of debris and unused equipment prior to construction work).

Project Expenditures and Reimbursement Summary

Typically, reimbursements are issued after the entire project is completed and paid for. For large projects with multiple phases or grantees that need assistance with cash flow from one phase to the next, they may request up to a total of 3 partial reimbursements after some work has been completed and paid for. Partial reimbursements must be coordinated and approved in advance, so please contact grants@nullpreservewa.org if you have any questions.

Total project cost to date*

Please list each project phase / work element, its cost, and what project element it was related to. Most grantees will only have one project phase. Use the “+” to the right of the boxes to add as many rows as you need. This step is SUMMARIZE only; you may attach a more detailed itemized expense spreadsheet later.

Project Phase / Work Element	Cash Expended	Value of Donated Labor & Materials	Owner Cash & In-kind Match	Grant Funds Reimbursed (if any already)	Grant Funds Expected (through this reimbursement)

Total reimbursement request at this time*

This amount should be total of “Grant Funds Expected” if you have multiple Project Phases or Work Elements from the input above. This amount should also not exceed the Grant Award as stated on your grant contract. Partial reimbursements must be coordinated and approved in advance, so please contact grants@nullpreservewa.org if you have any questions.

Supporting Documentation

In this section, upload digital copies of financial documents that relate to each item listed above in the “List of Project Expenses.” This should include receipts/invoices and proof of payment for each expense.

For items paid with credit card, please make sure the receipt(s) included contain both the itemized items purchased and the payment information. For items paid via check, please upload copies of each check. You may also include a report from accounting software such as QuickBooks or an detailed Excel spreadsheet that indicates work items, payee, payment type/check numbers, dates, and amounts.

Drop files here or

Max. file size: 50 MB.

Program Requirements

Check all that you have completed. If any are missing or you have questions about, please contact grants@nullpreservewa.org

Select All
The NPS Award Acknowledgement banner sign has been posted during the project
The Preservation Easement has been filed with the associated county
The property was already or has been listed on the National Register of Historic Places by project completion

Photo of the posted National Park Service Award Acknowlegment Sign

If you have already submitted it to staff, you may re-upload or skip.

Drop files here or

Max. file size: 50 MB.

Proof of filing the Preservation Easement with the county clerk

If you have already submitted it to staff, you may re-upload or skip. Proof includes the final draft of the easement and is notarized by the clerk.

Drop files here or

Max. file size: 50 MB.

Site Visits

Please note any virtual or in-person site visits conducted or planned with program staff.

Project Images

"BEFORE" PHOTOS

Please upload 4-6 high-resolution images of the building and project areas prior to work starting. You may re-upload or refer to your application photos.

Drop files here or

Max. file size: 50 MB.

IN-PROGRESS

Please upload 4-6 high-resolution images of the project in progress.

Drop files here or

Max. file size: 50 MB.

OVERALL IMAGES

Please upload 4-6 high-resolution images of the entire building / resource after project completion.

Drop files here or

Max. file size: 50 MB.

DETAIL IMAGES

Please upload 4-6 high-resolution images of the specific project area that the grant funds went toward, after project completion.

Drop files here or

Max. file size: 50 MB.

IMAGE CAPTIONS AND CREDITS

Please upload a text document with image captions and image credits that correspond with the file names of the images you are uploading.

Drop files here or

Accepted file types: txt, doc, docx, xls, xlsx, pages, Max. file size: 50 MB.

Submission

Thank you for completing the Third Places Grant program. Staff will review your completion report and reach out if we have any questions or if anything is missing. Reimbursement may take 2-4 weeks to process.

Please contact grants@nullpreservewa.org or call (206) 462-2999 if you have any questions.

Name

Email

Date

Additional Comments

Please use this prompt to provide any additional comments you may have regarding the grant program (staff, application, process, requirements, outreach, etc.) or contextualize any previous answers or file attachments.