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FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION <br /> BEACH MANAGEMENT FUNDING ASSISTANCE PROGRAM <br /> REQUEST FOR PAYMENT—PART II <br /> REIMBURSEMENT DETAIL <br /> Name of Project: Billing# Billing Period: DEP AGREEMENT NUMBER Invoice Adjustments(To be completed by DEP: <br /> Local Sponsor: Reasons for changes noted below) <br /> Eligible <br /> Item# Date OF I <br /> Project Item Total Amount Changes per BMFA Changes per Approved <br /> pproved <br /> INVOICE Invoice# Amount Paid Vendor(1) and SOWIBID# (3) Vendor Name Check or Debit# Eligible for Stats Eligible Cost <br /> Deliverable# Share(4) Project Manager (6,6) Accountant (6,6) (6) <br /> (2) <br /> 1 <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> Totals for all Items on page:, <br /> Item# Notes and invoice adjustment explanations per item#(6) <br /> Form Instructions: <br /> (1)Local Sponsor:enter exact amount of check or debit. <br /> (2)Local Sponsor:enter the subtask ID#from the Eligible Project Item table of the DEP Grant.Also add the Deliverable#that is eligible.(Ex.T2.1/D-A) <br /> (3)Scopes of work and bids that have been approved for DEP cost share may be assigned a tracking identifier number.Local Sponsor:Insert this tracking number when applicable. <br /> (4)Local Sponsor:insert only the amount of vendor payment that is assumed to be eligible for DEP cost share. <br /> (5)List retainage if retainage is being requested. <br /> DEP Agreement No. 14IR2, Attachment E, Page 2 of 4 <br /> 0 <br />