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Last modified
1/4/2021 11:20:46 AM
Creation date
9/19/2018 12:16:29 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Agreement
Approved Date
09/11/2018
Control Number
2018-169
Agenda Item Number
8.Y.
Entity Name
State of Florida Department of Environmental Protection
Subject
Standard Grant Agreement
Approval of FDEP Funding Agreement
Area
West Wabasso Phase II Septic to Sewer
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Instructions for Completing Request for Payment - Part II <br />Include the Grantee Name, Payment Request No., and DEP Agreement Number. List vendor invoices that are associated <br />with the Project by Task/Deliverable. <br />1 Invoice Amount: Amount of Invoice being submitted for reimbursement. <br />Local Share or Other Funding or Amount Not Requested: Portion of invoice paid for by Grantee,that is not <br />2 being requested for reimbursement by this grant <br />Requested Amount: Subtract Grantee's Local Share or Other Funding or Amount Not Requested (2) from Invoice <br />Amount (1). <br />Deliverable Number: Must identify completed deliverable(s) for each invoice. If invoice covers multiple <br />deliverables, that invoice would be listed multiple times, a line item for each deliverable with any portion not <br />applicable to that Task/Deliverable identified under (2). <br />Submittal Instructions <br />Instructions -for E -mailing: <br />The program now accepts reimbursement requests electronically. When scanning please be sure that the minimum scan <br />resolution must be 300 DPI (dots per inch). When reimbursement requests are sent electronically, please do not also <br />send a hard copy by postal mail. <br />Please redact all sensitive financial information from the invoices and other supporting documentation <br />to be submitted with this Payment Request Form. <br />Remit Payment Request by E-mail to the Department's Grant Manager. <br />Be sure the E-mail payment request includes the following: <br />Subject: Project Number_Disbursement Number: example — LP14025_Disb 1 <br />Attachments: <br />I ) Exhibit C Payment Request Summary <br />2) Request for Payment Part II Reimbursement Detail <br />3) Copies of invoices <br />4) Proof of payment (copies of canceled checks, front and back or EFT verification) <br />5) Other supporting documentation, as needed <br />For questions or concerns regarding these forms or if you would like'the payment request forms listed above in <br />electronic format please contact the Department's Grant Manager. <br />DEP Agreement No. NSO45 Exhibit C, Page 6 of 6 <br />
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