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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 #: 4283-91-R <br />PROGRAM: Hazard Mitigation Grant Program CONTRACT #: H0566 <br />2 Recipient's internal 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 recipients 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 />48 137 <br />REF NOz <br />DATE <br />DOCUMENTATION 4 <br />(Check) <br />AMOUNT <br />ELIGIBLE <br />COSTS <br />100% <br />1 <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 />3 Date of delivery of articles, completion of work or performance services. (per document) <br />4 List Documentation (Recipient's payroll, material out of recipients 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 />48 137 <br />