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FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION <br /> BEACH MANAGEMENT FUNDING ASSISTANCE PROGRAM <br /> CERTICATION OF DISBURSEMENT REQUEST <br /> REQUEST FOR PAYMENT—PART IV <br /> Name of Project: INDIAN RIVER COUNTY HURRICANE REPAIR PROJECT <br /> LOCAL SPONSOR: INDIAN COUNTY DEP Agreement Number: 14IR2 <br /> Billing Number: <br /> Certification: I certify that this billing is correct and is based upon actual obligations of record by the LOCAL <br /> SPONSOR; that payment from the State Government has not been received; that the work and/or services are in <br /> accordance with the Department of Environmental Protection, Beach Management Funding Assistance Program's <br /> approved Project Agreement including any amendments thereto; and that progress of the work and/or services are <br /> satisfactory and are consistent with the amount billed. The disbursement amount requested on Page 1 of this form is for <br /> allowable costs for the project described in the grant work plan. <br /> I certify that the purchases noted were used in accomplishing the project; and that invoices,check vouchers,copies of <br /> checks,and other purchasing documentation are maintained as required to support the cost reported above and are <br /> available for audit upon request. <br /> Name of Project Administrator Signature of Project Administrator Date <br /> Name of Project Financial Officer Signature of Project Financial Officer Date <br /> DEP Agreement No. 14IR2, Attachment E, Page 4 of 4 <br /> 52 <br />