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Attachment D <br />FINANCIAL INVOICE FORM <br />FOR <br />HAZARDOUS MATERIALS HAZARDS ANALYSIS UPDATE <br />RECIPIENT: Indian River County <br />FEID#: 59-6000674 <br />DUNS#: <br />AGREEMENT# 15 -CP -11 -10 -40 -01 -XXX <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 />AMOUNT AMOUNT AP <br />REQUESTED BY THE <br />BY THE RECIPIENT DIVISION <br />TOTAL AMOUNT $ $ <br />(To be complete <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 <br />Date <br />TOTAL AMOUNT TO BE PAID AS OF <br />THIS INVOICE $ <br />23 <br />VED <br />i by <br />157 <br />