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EXHIBIT C <br />FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION <br />BEACH MANAGEMENT FUNDING ASSISTANCE PROGRAM <br />REQUEST FOR PAYMENT <br />PART 1— PAYMENT SUMMARY <br />Name of Project: Indian River County 2022 Hurricane Ian and Nicole Recovery Project <br />Local Sponsor: Indian River County <br />DEP Agreement Number: 23IR2 <br />Remittance Mailing Address: <br />Billing Number: <br />Billing Type: ❑ Interim Billing <br />Costs Incurred This Payment Request <br />Federal Share* State Share <br />*if applicable, check box below <br />❑ FEMA ❑ USACE <br />Cost Summary: <br />State Funds Obligated <br />Less Advance Pay <br />Less Previous Payment <br />Less Previous Retained <br />Less This Payment <br />Less This Retainage <br />State Funds Remaining <br />❑ Final Billing <br />DEP Agreement No. 23IR2, Exhibit C, Page 1 of 6 <br />Local Share Total <br />Local Funds Obligated <br />Less Advance Pay <br />Less Previous Credits <br />Less This Credit <br />d' <br />Local Funds Remaining <br />