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ATTACHMENTI <br />FINANCIAL INVOICE FORM <br />2020-2021 HAZARDS ANALYSIS GRANT AGREEMENT <br />RECIPIENT: Indian River County <br />AGREEMENT #: <br />T0097 <br />ADDRESS: <br />PERIOD OF PERFORMANCE: <br />FEIN #: <br />DELIVERABLES & INVOICE AMOUNTS <br />AMOUNT <br />AMOUNT <br />REQUESTED <br />APPROVED <br /># <br />MINIMUM PERFORMANCE REQUIREMENTS <br />BUDGET AMOUNT <br />PER DELIVERABLE <br />BY <br />SUB -RECIPIENT <br />BY <br />FDEM <br />No later than November 15, 2020, provide <br />completed CAMEOf n files for 25% of <br />40% of HA <br />1 <br />facilities listed in Attachment H. <br />Agreement <br />$1,165.20 <br />Hazards Analysis submissions are reviewed and <br />Amount <br />must be approved before invoice is submitted. <br />No later than March 15, 2021, provide <br />completed CAMEOfm files for 25% of <br />40% of HA <br />2 <br />facilities listed in Attachment H. <br />Agreement <br />$1,165.20 <br />Hazards Analysis submissions are reviewed and <br />Amount <br />must be approved before invoice is submitted. <br />No later than June 15, 2021, provide a complete <br />correct copy of the "approved" HA CAMEOf n file <br />20% of HA <br />3 <br />to the LEPC and FDEM with a copy of the <br />Agreement <br />$582.60 <br />transmittal letter. Upload the final "approved" <br />Amount <br />CAMEOfin zip file into SharePoint folder. <br />TOTAL AMOUNTS: <br />$0.00 <br />TO BE COMPLETED <br />BY FDEM <br />I certify to the best of my knowledge and belief the billed costs are in accordance with the <br />Terms and Conditions of the Hazards Analysis Agreement. <br />Signature ofAuthorized Official Date <br />TOTAL HA GRANT AMOUNT: <br />AMOUNT PREVIOUSLY PAID: <br />AMOUNT PAYABLE THIS INVOICE: <br />REMAINING BALANCE: <br />, <br />36 2020.21 ILA Attachment lFlnancialInvoice Form Updatelel.%2020 <br />