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A TRUE COPY <br />CE=RTIFICATION ON LAST PAGE <br />J.R. SMITH, CLERK <br />Attachment I <br />Financial Invoice Form <br />2022-2023 Hazard Analysis Grant Agreement <br />Recipient: <br />Grant Agreement#: <br /># I Minimum Performance Requirements <br />Deliverable & Invoice Amounts <br />Budget amountI Amount requested by Sub - <br />per Deliverable Recipient <br />No later than November 1, 2022, provide <br />completed CAMEO Data Manager files for 25% of 40% of HA <br />1 facilities listed in Attachment H. Agreement <br />Hazards Analysis submissions are reviewed and <br />must be approved before invoice is submitted. Amount <br />No later than March 1, 2023, provide completed <br />CAMEO Data Manager files for 25% of 40% of HA <br />2 1 facilities listed in Attachment H. Agreement <br />Hazards Analysis submissions are reviewed and Amount <br />must be approved before invoice is submitted. <br />No later than June 1, 2023, provide a complete <br />correct copy of the "approved" CAMEO Data Manager 20% of HA <br />3 file to the LEPC and FDEM with a copy of the Agreement <br />transmittal letter. Amount <br />TOTAL AMOUNTS: I $0.00 <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 />Printed Name and Title <br />Recipient Signature <br />Date <br />29 HA Attachment I Financial Invoice Form 616/2022 <br />