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A TRUE COPY <br />CERTIFICATION ON LAST PAGE <br />R. SMITH, CLERK <br />ATTACHMENTI <br />FINANCIAL INVOICE FORM <br />2021-2022 HAZARDS ANALYSIS GRANT AGREEMENT <br />RECIPIENT: I Indian River County AGREEMENT #: T0149 <br />ADDRESS: 14225 43rd Avenue Vero Beach FL 32967 <br />I PERIOD OF PERFORMANCE: I I FEIN #: <br />2021-22 HA Attachment] Financial Invoice Form 412612021 <br />27 <br />DELIVERABLES & INVOICE AMOUNTS <br />AMOUNT <br />AMOUNT <br />REQUESTED <br />APPROVED <br /># <br />MINIMUM PERFORMANCE REQUIREMENTS <br />BUDGET AMOUNT <br />BY <br />BY <br />PER DELIVERABLE <br />SUB -RECIPIENT <br />FDEM <br />No later than November 1, 2021, provide <br />completed CAMEO Data Manager files for 25% of <br />40% of HA <br />1 <br />facilities listed in Attachment H. <br />Agreement <br />$743.62 <br />Hazards Analysis submissions are reviewed and <br />must be approved before invoice is submitted. <br />Amount <br />No later than March 1, 2022, provide completed <br />CAMEO Data Manager files for 25% of <br />40% of HA <br />2 <br />facilities listed in Attachment H. <br />Agreement <br />$743.62 <br />Hazards Analysis submissions are reviewed and <br />Amount <br />must be approved before invoice is submitted. <br />No later than June 1, 2022, provide a complete <br />correct copy of the "approved" CAMEO Data Manager <br />20% of HA <br />3 <br />file to the LEPC and FDEM with a copy of the <br />Agreement <br />$371.81 <br />transmittal letter. Upload the final "approved" <br />Amount <br />CAMEO Data Manager zip file into SharePoint folder. <br />TOTAL AMOUNTS: <br />$0.00 <br />TO BE COMPLETED <br />BY FDEM <br />I certifyto the best of m knowledge and belief <br />Y g the billed costs are in accordance with the <br />Terms and Conditions of the Hazards Analysis Agreement. <br />Signature ofAuthorized Oficial Date <br />TOTAL HA GRANT AMOUNT: $1,859.05 <br />AMOUNT PREVIOUSLY PAID: <br />AMOUNT PAYABLE THIS INVOICE: <br />REMAINING BALANCE: <br />GRANT MANAGER INITIALS: <br />2021-22 HA Attachment] Financial Invoice Form 412612021 <br />27 <br />