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Instructions for Completing Request for Payment - Part II Include the Grantee Name, Payment Request No., and DEP Agreement Number. List vendor invoices that are associated with the Project by Task/Deliverable. 1 Invoice Amount: Amount of Invoice being submitted for reimbursement. Local Share or Other Funding or Amount Not Requested: Portion of invoice paid for by Grantee,that is not 2 being requested for reimbursement by this grant Requested Amount: Subtract Grantee's Local Share or Other Funding or Amount Not Requested (2) from Invoice Amount (1). Deliverable Number: Must identify completed deliverable(s) for each invoice. If invoice covers multiple deliverables, that invoice would be listed multiple times, a line item for each deliverable with any portion not applicable to that Task/Deliverable identified under (2). Submittal Instructions Instructions for E -mailing: The program now accepts reimbursement requests electronically. When scanning please be sure that the minimum scan resolution must be 300 DPI (dots per inch). When reimbursement requests are sent electronically, please do not also send a hard copy by postal mail. Please redact all sensitive financial information from the invoices and other supporting documentation o be submitted with this Payment Request Form. Remit Payment Request by E-mail to the Department's Grant Manager. Be sure the E-mail payment request includes the following: Subject: Project Number—Disbursement Number: example — LP14025_Disb 1 Attachments: 1) Exhibit C Payment Request Summary 2) Request for Payment Part II Reimbursement Detail 3) Copies of invoices 4) Proof of payment (copies of canceled checks, front and back or EFT verification) 5) Other supporting documentation, as needed For questions or concerns regarding these forms or if you would like the payment request forms listed above in electronic format please contact the Department's Grant Manager. DEP Agreement No. ABO 10, Exhibit C, Page 6 of 6