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ATTACHMENT E <br />FINANCIAL INVOICE FORM <br />FOR <br />HAZARDOUS MATERIALS HAZARDS ANALYSIS UPDATE <br />RECIPIENT: AGREEMENT# <br />PERIOD OF PERFORMANCE FEIN# <br />AMOUNT AMOUNT APPROVED <br />REQUESTED BYTHE <br />BY THE RECIPIENT DIVISION <br />1. First Payment (45% of contract amount) <br />(50% Hazards Analysis submitted and approved) <br />2. Second Payment (45% of contract amount) <br />1 (50% Hazards Analysis submitted and approved) <br />3. Final Payment (10% of contract amount) <br />(Approval, distri I bution & notificati on) <br />TOTAL AMOUNT <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 />Printed Name and Title of Authorized Official <br />Signature of Authorized Official Date <br />�L AMOUNT TO BE PAID AS OF <br />INVOICE $ <br />(To be completed bv the Division) <br />27 <br />P213 <br />