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SUMMARY OF DOCUMENTATION IN SUPPORT OF AMOUNT <br />CLAIMED FOR ELIGIBLE DISASTER WORK UNDER THE <br />HAZARD MTIGATION ASSISTANCE PROGRAM <br />SUB -RECIPIENT: INDIAN RIVER COUNTY PAYMENT #: <br />PROJECT TYPE: WILDFIRE MITIGATION PROJECT #: <br />4283-95-R <br />PROGRAM: Hazard Mitigation Grant Program CONTRACT #: H0259 <br />2 Recipient's internal reference number (e.g., Invoice, Receipt, Warrant, Voucher, Claim Check, or Schedule #) <br />' Date of delivery of articles, completion of work or performance services. (per document) <br />List Documentation (Recipient's payroll, material out of recipient's stock, recipient owned equipment and name of vendor or <br />contractor) by category (Materials, Labor, Fees) and line item in the approved project line item budget. Provide a brief description of <br />the articles or services. List service dates per each invoice. <br />174 <br />REF NO2 <br />DATES <br />DOCUMENTATION° <br />(Check) <br />AMOUNT <br />ELIGIBLE <br />COSTS <br />100% <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />8 <br />9 <br />This payment represents % completion of the project. TOTAL <br />2 Recipient's internal reference number (e.g., Invoice, Receipt, Warrant, Voucher, Claim Check, or Schedule #) <br />' Date of delivery of articles, completion of work or performance services. (per document) <br />List Documentation (Recipient's payroll, material out of recipient's stock, recipient owned equipment and name of vendor or <br />contractor) by category (Materials, Labor, Fees) and line item in the approved project line item budget. Provide a brief description of <br />the articles or services. List service dates per each invoice. <br />174 <br />