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I <br />FLORIDA DEPARTMENT OF <br />BEACH MANAGEMENT FU <br />CERTIFICATION OF ] <br />REQUEST FOR <br />Name of <br />Local <br />DEP Agreement Number: 17IR1 <br />Billing Number: <br />Certification: I certify that this billing is correct ar <br />Sponsor; that payment from the State Government <br />in accordance with the Department of Environmei <br />Program's approved Project Agreement including <br />and/or services are satisfactory and are consiste <br />requested on Page 1 of this form is for allowable c <br />I certify that the purchases noted were used in ac <br />copies of checks, and other purchasing docui <br />reported above and are available for audit upon <br />Name of Project Administrator <br />Name of Project Financial Officer <br />DEP Agreement No. 17IR1, Exhibit D, Page 4 of 4 <br />:)NMENTAL PROTECTION <br />ASSISTANCE PROGRAM <br />;BURSEMENT REQUEST <br />YMENT — PART IV <br />Sector 3 <br />is based upon actual obligations of record by the Local <br />as not been received; that the work and/or services are <br />it Protection, Beach Management Funding Assistance <br />iy amendments thereto; and that progress of the work <br />with the amount billed. The disbursement amount <br />is for the Project described in the grant work plan. <br />ng the Project; and that invoices, check vouchers, <br />are maintained as required to support the cost <br />ect <br />Date <br />ect Financial Officer Date <br />