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ATTACHMENT B <br /> Disbursement Request Package <br /> Legislative Projects (LP) Grants <br /> 1 . Grantee/Recipient Indian River County <br /> 2. Project Number LP6734 Date of Request <br /> 3 . Disbursement Request Number Required Match % <br /> 4. Type of Request: Partial ❑ Final ❑ <br /> 5 . Federal Employer Identification Number <br /> 6 . Mail ❑ EFT ❑ Send Remittance to : <br /> Disbursement Details <br /> (cumulative amounts rounded to the nearest dollar) <br /> 1 . Planning (attach invoices) $ <br /> 2. Engineering (attach invoices) <br /> 3 . Construction and Demolition (attach invoices <br /> 4. Technical Services during Construction (attach invoices) <br /> 5 . Other (list - must be specified in agreement) <br /> 6. Total cumulative to date $ <br /> 7 . Disbursements previously requested $( ) <br /> 8. Amount requested for disbursement (line 6 minus line 7) $ <br /> Requests for Invoices already Paid : Requests for Invoices not yet Paid: <br /> 1) Copy of Invoice 1) Copy of Invoice <br /> 2) Proof of Payment 2) Advance Payment Justification (one per quarter) <br /> 3) Advance Payment — Interest Earned (after initial advance) <br /> *If prior Disbursement Request was requested by invoices without proof of payment documentation, proof of the <br /> prior payment will be required before this request can be disbursed. <br /> ** SUBMIT ONE ORIGINAL COPY OF THIS FORM AND SUPPORTING DOCUMENTATION TO: ** <br /> Florida Department of Environmental Protection <br /> Bureau of Water Facilities Funding MS 3505 <br /> 2600 Blair Stone Road <br /> Tallahassee, Florida 32399-2400 <br /> DEP Agreement No. LP6734, Attachment B, Page I of 3 <br />