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2015-236
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2015-236
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Last modified
4/23/2018 1:44:45 PM
Creation date
12/9/2015 11:01:55 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Second Amendment
Approved Date
12/08/2015
Control Number
2015-236
Agenda Item Number
8.G.
Entity Name
Florida Department Environmental Protection.
Division of Water Restoration Assistamce
Subject
Amendment No.2 to FDEP Grant Agreement 141R2
Dune Repair Project
Hurricane Repair Project
Area
Sector 3
Project Number
Agreement #141R2
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FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION <br />BEACH MANAGEMENT FUNDING ASSISTANCE PROGRAM <br />REQUEST FOR PAYMENT — PART II <br />Name of Project - Billing Period (1): <br />Billing Number <br />DEP Agreement Number <br />Person Completing Form & Telephone Number (2): <br />REIMBURSEMENT DETAIL <br />Item # <br />Vendor <br />Name <br />Invoice <br />Number <br />Invoice <br />Date <br />Check <br />Number <br />Deliverable <br />Number (3) <br />Invoice <br />Amount(4) <br />Eligible <br />Cost <br />(5) <br />% Fed <br />Share <br />(6) <br />Federal <br />Share of <br />Invoice <br />Amount(8) <br />(7)"" <br />Non- <br />Federal <br />Share <br />State <br />Share <br />(9) <br />State <br />Share <br />(10) <br />Local <br />Share <br />(11) <br />Retainage <br />Payment <br />(12) <br />Withheld <br />Retainage <br />(13) <br />State <br />Payment <br />(14) <br />- <br />50.00 <br />0.00 <br />0.00 <br />0.00 <br />- <br />Totals <br />- <br />- <br />- <br />- <br />- <br />- <br />Total Due to Local Sponsor (15) <br />Form Instructions: <br />1. Billing Period: Should reflect Invoice services performed date. (beginning date - earliest date of services, end date - latest date of services performed). <br />2. Person responsible for completing this form: Please identify the person responsible for completing information if clarification is needed. <br />3. Deliverable #: Must identify completed deliverable(s) for each invoice. If invoice covers multiple deliverables, that invoice would be listed multiple times, a line item for each deliverable. <br />4. Invoice Amount <br />5. Eligible Cost: Invoice amount paid by Local Sponsor less ineligible cost for Line Item Deliverable only. <br />6. %Federal Share: If applicable this should be the percentage listed in Agreement. Federal Share will be listed on Table 1 if applicable. <br />7. Federal Share: If applicable, Local Sponsor will multiply Eligible Cost by Federal Share Percentage. <br />8. Non -Federal Share: Eligible Cost (5) minus Federal Share of Invoiced Amount (7). • <br />9. Percentage of State Share: This should be the State Share Percentage listed in Agreement. <br />10. State Share: Multiply Non -Federal Share by State Share Percentage. <br />11. Local Share: Subtract State Share from Non -Federal Share. <br />12. Retainage Payment: Requires separate line for each completed Task, Sub -Task and or Deliverable that retainage is being requested. <br />13. Withheld Retainage: Multiply State Share by 10%. <br />14. State Payment: Subtract Retainage from State Share. <br />15. Total Due to Local Sponsor: Add Retainage Payment Total (12) to State Payment Total (14). <br />Notes: For questions or concerns regarding this form please contact: Janice Simmons - (850)245-2978 or email at Janice.L.Simmons@dep.state.fl.us <br />DEP Agreement No. 14IR2, Amendment No. 2, Attachment C, Page 2 of 5 <br />
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