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ATTACHMENT B <br />FLORIDA DEPARTMENT OF NATURAL RESOURCES <br />DIVISION OF BEACHES AND SNORES <br />Erosion Control Program <br />Request For Payment <br />1. Name of Project: 2. Billing No. <br />3. Grantee: 4. Billing Period: <br />5. Payment Requested: <br />k. Type of Costs Incurred: <br />Direct Stock Contractual <br />Labor Cost Material Cost Material Cost Cost Total Cost <br />Erosion Control <br />Sand Search <br />coni tori ng <br />notal Cost <br />1. Share of Costs Incurred: <br />State Share of Total Cost Local Share of Total Cost <br />:rosion Control Erosion Control <br />;and Search Sand Search <br />Toni tori_ng Monitoring <br />.otal Total <br />.ote: The total state share plus the total local share of cost incurred must equal the <br />total of all cost incurred as identifed in "A" (Type of Costs Incurred). <br />�. State Funds Obligated: <br />Less Previous Payments: <br />Less This Payment: <br />Less Retainage (lOb): <br />State Funds Remaining: <br />Local Funds Obligated: <br />Less Previous Credits: <br />Lest This Credit: <br />Local Funds Remaining: <br />CERTIFICATION: I certify that this billing is correct and just and is based upon <br />actual obligation(s) of record by the project sponsor; that payment from the State <br />Government has not been received; that the work and/or services are in accordance <br />with the Department os Natural Resources, Division of Beaches and Shores' approved <br />project agreement including any amendments thereto; and that progress of the work <br />and/or services are satisfactory and are consistent with the amount billed. <br />Name of Project Tdministrator Signature of Project Administrator Date <br />Name of Project Financial Signature of ProjectinancT a ate <br />Officer Officer <br />)NP. Form 72-101 (4-83) <br />JUN 6 1884 �oo� 57 Favi 329 <br />