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DocuSign Envelope ID: 4F49ED83-A0E8-4535-BBB4-F1419D233380 <br />Agreement # P0307 <br />Attachment 1-C — Invoice: Combination of Grantee's Subcontractor(s) and Grantee's Employee(s) <br />INVOICE <br />GRANTEE'S NAME: <br />FEIN: <br />Agreement No.: <br />TO: <br />Florida Department of Economic Opportunity <br />Division of Community Development <br />Attn.: Stella Lewis <br />107 East Madison Street <br />Caldwell Building, MSC 160 <br />Tallahassee, FL 32399 <br />INVOICE NO.: <br />INVOICE DATE: <br />FOR: <br />[Grantee name] <br />[Grantee address] <br />[Grantee phone number] <br />DESCRIPTION <br />AMOUNT <br />Dates of Service: <br />Deliverable Completed: <br />[copy description of the deliverable from Scope of Work, Section 3] <br />Category expenditures: <br />Contractual Services <br />$ <br />Salaries <br />$ <br />Fringe Benefits <br />$ <br />Travel <br />$_ <br />Postage <br />$_ <br />[other direct costs: identify them] <br />$_ <br />TOTAL <br />$_ <br />Page 29 of 37 <br />Rev. 9/27/18 <br />82 <br />