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Attachment C <br /> FINANCIAL INVOICE FORM <br /> FOR <br /> HAZARDOUS MATERIALS HAZARDS ANALYSIS UPDATE <br /> RECIPIENT : Indian River County AGREEMENT# 12 - CP - 03- 10-40- 01 - 196 <br /> AMOUNT AMOUNT APPROVED <br /> REQUESTED BY THE <br /> BY THE RECIPIENT DIVISION <br /> 1 . First Payment ( 45 % of contract amount) $ $ <br /> ( 50 % Hazards Analyses completed/submitted ) <br /> 2 . Second Payment (45 % of contract amount) $ $ <br /> ( 50 % Hazards Analyses completed/submitted ) <br /> 3 . Final Payment( 10 % of contract amount) $ $ <br /> ( approval , distribution & notification ) <br /> TOTAL AMOUNT $ $ <br /> (To be completed by <br /> the Division ) <br /> I certify that to the best of my knowledge and belief the billed costs are in accordance with the <br /> terms of the Agreement . <br /> Signature of Authorized Official/Title Date <br /> TOTAL AMOUNT TO BE PAID AS OF <br /> THIS INVOICE $ <br /> ( To be completed by the Division ) <br /> ' r7 <br /> Cr) <br /> U ) <br /> F -� <br /> CD <br />