Laserfiche WebLink
Attachment C <br /> FINANCIAL INVOICE FORM <br /> FOR <br /> HAZARDOUS MATERIALS HAZARDS ANALYSIS UPDATE <br /> COUNTY : Indian River County AGREEMENT # : 11 - CP-03- 10-40 -01 -216 <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 />