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Attachment F <br />Financial Invoice Form <br />For <br />Hazardous Materials Hazards Analysis Update <br />RECIPIENT: <br />ADDRESS: <br />PERIOD OF PERFORMANCE: <br />1. First Payment (40% of contract amount) <br />(25% Hazards Analysis submitted) <br />2. Second Payment (40% of contract amount) <br />(25% Hazards Analysis submitted) <br />AGREEMENT# <br />FEIN# <br />AMOUNT <br />REQUESTED <br />BY THE RECIPIENT <br />3. Final Payment (20% of contract amount) $ <br />(HA's approved, Notifications & zip file uploaded) <br />AMOUNT APPROVED <br />BY THE <br />DIVISION <br />d' <br />TOTAL AMOUNT $ $ <br />(to be completed <br />by 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 <br />Total HA Update Grant amount: <br />Total amount previously paid: <br />Total amount payable this invoice: <br />Remaining balance: <br />Date <br />(To be completed by the Division) <br />27 <br />