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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 />AGREEMENT# <br />1. First Payment (40% of Contract Amount) <br />(25% Hazards Analysis Submitted) <br />FEIN# <br />AMOUNT AMOUNT APPROVED <br />REQUESTED BY THE <br />BY THE RECIPIENT DIVISION <br />2. Second Payment (40% of Contract Amount) $ $ <br />(25% Hazards Analysis Submitted) <br />3. Final Payment (20% of Contract Amount) $ $ <br />(HA's Approved, Notifications & Zip File Uploaded) <br />TOTAL AMOUNT <br />$ $ <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 />Date <br />Total HA Update Grant Amount: <br />Total Amount Previously Paid: <br />Total Amount Payable This Invoice: <br />Remaining Balance: <br />(To Be Completed by the Division) <br />28 <br />