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Public Safety, Essential Services Tax Quarterly Reports

  1. Public Safety & Essential Services Quarterly Reports Form
    Each quarter, agencies that receive funds from the Humboldt County Local Public Safety and Essential Services tax must submit reports to the county on a quarterly basis detailing their expenditures and activities carried out with the funding they have received. This form is used to submit that information.
  2. The agency submitting this report
  3. Quarter*
  4. I. Quarterly Narrative


    Reponses to questions below can be copy/pasted from the narrative attachment you include at right. Responses are being included here for ease of review.

  5. Fill out this form, save to your computer then upload it above.

    Please attach PDFs Only

  6. Please quantify the short-term impact of your project for the current year. If you have evaluation materials that document outcomes and impacts of your work, feel free to attach them in lieu of answering this or other questions.

  7. This would be for the entire time period that Measure Z has funded your project. 

  8. II. Final Summary Report

    Lessons Learned

  9. Invoice and Budget Form Submissions
  10. Fill out this form, save to your computer then upload the invoice above and the budget to the right.

    Please attach PDFs Only

  11. Please attach PDFs Only

  12. See "Invoice" directions to the left. 

    Please attach PDFs Only

  13. Please attach PDFs Only

  14. Additional Attachments

    If you need to submit more attachments than this form allows, please submit what you can and fill out another form.

  15. Communication with Community
  16. Have you posted your quarterly update to social media?*
  17. Exhibit D of your agreement discusses social media reporting requirements
    Example social media posts could read: “#MeasureZ update: Over the last quarter we [____brief description of Measure Z activities completed and/or total numbers served____]. During our efforts this quarter we’ve seen [____brief description of the difference Measure Z funding has made in our community and for the population you are serving____].
  18. Please provide any photos you have related to your Measure Z project. Please note that any photos you provide may be shared by the county, and does not replace your requirement to communicate about your Measure Z project, per the terms of your MOU with the county. By uploading photos, you are confirming that any people photographed have either agreed to have their photos taken and shared publicly, or doing so is allowed by law. 

  19. Please provide a caption for your photo that identifies any individuals who are in the photo, and the action and context of the photo. And please make sure to credit the photographer.

  20. Do you have any notes or special instructions for your report submission?
  21. Leave This Blank:

  22. This field is not part of the form submission.