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Attachment D <br /> FINANCIAL INVOICE FORM <br /> FOR <br /> HAZARDOUS MATERIALS HAZARDS ANALYSIS UPDATE <br /> RECIPIENT Indian River County AGREEMENT# 17-CP-11-10-40-01-XXX <br /> AMOUNT AMOUNT APPROVED <br /> REQUESTED BY THE <br /> BY THE RECIPIENT DIVISION <br /> 1 First Payment (45%of contract amount) $ $ <br /> (50% Hazards Analyses submitted and approved) <br /> 2. Second Payment(45% of contract amount) $ $ <br /> (50% Hazards Analyses submitted and approved) <br /> 3. Final Payment(10% of contract amount) $ $ <br /> (approval, distribution & notification) <br /> TOTAL AMOUNT $ $ <br /> (To be completed by <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 Date <br /> TOTAL AMOUNT TO BE PAID AS OF <br /> THIS INVOICE $ <br /> (To be completed by the Division) <br /> 26 <br /> 232 <br />