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PROJECT NAME: <br />EXHIBIT D <br />FLORIDA INLAND NAVIGATION DISTRICT <br />ASSISTANCE PROGRAM <br />PAYMENT REIMBURSEMENT REQUEST FORM <br />PROJECT #: <br />PROJECT SPONSOR: BILLING #: <br />Amount of Assistance A. <br />Less Previous Total Disbursements B. <br />and Less Previous Total Retainage <br />Held Balance Available = <br />Funds Requested This Disbursement <br />Funds Requested C. <br />Less Retainage (-10% unless final) D. <br />Check Amount = <br />Amount of Assistance <br />Less Total Prior and Current <br />Payments Including all retainage <br />held (A -B -C -D) - <br />= Balance Remaining <br />SCHEDULE OF EXPENDITURES <br />Expense Description Check No. Total Applicant FIND <br />(Should correspond to Vendor Name and Date Cost Cost Cost <br />Cost Estimate Sheet <br />Categories in Exhibit 'W') <br />FIND - Form No. 90-14 <br />Effective Date 7-30-02) <br />(NOTE: Signature Required on Page 2) <br />66 <br />