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FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION <br />FLORIDA BEACH EROSION CONTROL PROGRAM <br />REQUEST FOR PAYMENT <br />Name of Project: Ambersand/Wabasso Beach Restoration Project <br />Grantee: Indian River county DEP Contract Number: 981R1 <br />Billing Number: Billing Period: <br />Cost. Inwrrad This Payment Reguast <br />Total Cost Local Shat. State Share Federal Share <br />Contractual <br />Cast s;®ary <br />State Funds Obligated $184,738 Local Funds Obligated $184,738 <br />Leas Previous Payment Les. Previous Credits <br />Less This Payment Less This Credit <br />Less Retainage (108) <br />Less Previous Retained <br />State Funds Remaining Local Funds Remaining <br />Certification: I certify that this billing ie ...east <br />est and is based upon actual <br />obligations of record by the grantee; that paymantFrom the State Oever went hes net been <br />wived; that the week and/or e.rvioes sea, in <br />ac.sdance with the Departsent of <br />B;rvieuseartal Protection, Baas. of Beach.. andCo..tal System's approved Project <br />Agreassent including any amendments thereto; and that progress of the work and/or services <br />are utisfeotory and are consistent with the amount billed. <br />Name of Project Administrator Signature of Project Administrator Data <br />Neve of Project Financial Officer Sigmture of Project Financial Officer Data <br />