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FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION <br />BEACH MANAGEMENT FUNDING ASSISTANCE PROGRAM <br />REQUEST FOR PAYMENT <br />PART 2 - REIMBURSEMENT DETAIL <br />DEP AGREEMENT NUMBER: <br />NAME OF PROJECT: <br />BILLING NUMBER: <br />BILLING PERIOD: (1) <br />Individual completing form & telephone number: (2) <br />Item Invoice <br /># Vendor Name Number <br />Invoice <br />Date <br />Check <br />Number <br />Task SOW # <br /># (3) (3) <br />Invoice Amount Eligible Amount <br />(4) (5) <br />%Fed Share <br />(6) <br />Federal Share of Non -Federal <br />Eligible Amount Share (8) <br />(7) <br />% State <br />Share <br />(9) <br />State Share (10) <br />Local Sh <br />- - <br />0.00 <br />- <br />0.00 <br />- <br />0.00 <br />- <br />0.00 <br />- <br />0 00 <br />- <br />0,00 <br />- <br />0.00 <br />- <br />0.00 <br />- <br />000 <br />- <br />0.00 <br />- <br />000 <br />- <br />0.00 <br />- <br />000 <br />- <br />0.00 <br />- <br />0.00 <br />- <br />0.00 <br />- <br />0.00 <br />Totals: <br />- <br />- - <br />- <br />Tota I <br />