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SUMMARY OF DOCUMENTATION IN SUPPORT OF AMOUNT <br />CLAIMED FOR ELIGIBLE DISASTER WORK UNDER THE <br />HAZARD MITIGATION ASSISTANCE PROGRAM <br />SUB -RECIPIENT: INDIAN RIVER COUNTY , PAYMENT #: <br />PROJECT TYPE: Elevation PROJECT #: <br />A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />J.R. SMITH, CLERK <br />4283-91-R <br />PROGRAM: Hazard Mitigation Grant Program CONTRACT M H0566 <br />- Recipients inrernai reference number (e.g., Invoice, Receipt, Warrant, Voucher, Claim Check, or Schedule #) <br />3 Date of delivery of articles, completion of work or performance services. (per document) <br />4 List Documentation (Recipient's payroll, material out of recipient's stock, recipient owned equipment and <br />name of vendor or contractor) by category (Materials, Labor, Fees) and line item in the approved project line <br />item budget. Provide a brief description of the articles or services. List service dates per each invoice. <br />47 <br />REF NOZ <br />DATE <br />DOCUMENTATION 4 <br />(Check) <br />ELIGIBLE <br />AMOUNT <br />COSTS <br />100% <br />1 <br />F,� <br />3 }y 3x' 'a <br />c�.f S 3,. �-7P <br />�' �r ? 3 My 3' x: v" l n y+• � q`� � E• ,.{f M �i �m <br />5 's .. 3 j � <br />� 4 <br />y.c 2,5 <br />:�. y... <br />Jv,'+ ..nZ�4 r°'., <br />_ <br />_tr3� u� - r5 .. l:i. e£=# . ,.f= t•;�' 'y f5c5 c=(` -ter". ^'�civS <br />„; yl <br />,'Y <br />2 <br />'�-„i d <br />k �' T£X T'f <br />( fi e "-f'f C <br />;S F t i.: ri 4 }�a: ”. P ,.3 t «E.. £ k'TI,'. <br />4. tT <br />2 k-�• _ <br />_: <br />wit <br />`3 <br />, <br />- <br />5 <br />e <br />� <br />- � 3.1 u� a` �*-x L..�`r" Yfr4 <br />� <br />� ` <br />� <br />q4r .� ?-� �'-..c��r•�` <br />� <br />q'i <br />�-4rf <br />E Y <br />=` <br />8 <br />Ng <br />I <br />]t}F. <br />9 <br />�x <br />t ] fh .%;' _ <br />�{ ! tu.:l <br />3 `y } f : Y _- vs -�• "'� Y '` - <br />�. <br />:. d+ <br />r— <br />C.S' i <br />` <br />v1 <br />.,. <br />This payment represents % completion of the project TOTAL <br />- Recipients inrernai reference number (e.g., Invoice, Receipt, Warrant, Voucher, Claim Check, or Schedule #) <br />3 Date of delivery of articles, completion of work or performance services. (per document) <br />4 List Documentation (Recipient's payroll, material out of recipient's stock, recipient owned equipment and <br />name of vendor or contractor) by category (Materials, Labor, Fees) and line item in the approved project line <br />item budget. Provide a brief description of the articles or services. List service dates per each invoice. <br />47 <br />