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40 <br />r <br />ATTACHMENT B <br />FISH AND WILDLIFE CONSERVATION COMMISSION <br />DIVISION OF MARINE FISHERIES <br />BUREAU OF MARINE FISHERIES MANAGEMENT <br />ARTIFICIAL REEF PROGRAM <br />REQUEST FOR PAYMENT <br />Grantee: <br />Project Title: <br />Grant Agreement: <br />'Pilling Number: <br />Billing Period: <br />Amount of Funds Appropriated <br />Amount of Reimbursement Requested <br />Less Previous payments <br />Amount of Funds Remaining <br />CERTIFICATION: I certify that this billing is correct and just, and is based on actual obligation(s) of <br />record by the project sponsor; that the work and/or other services are in accordance with the Fish and <br />Wildlife Conservation Commission, Division of Marine Fisheries Grant Agreement (including any <br />amendments thereto), and that the progress of the work and/or services are satisfactory and are <br />consistent with the amount billed. <br />Name of Individual with Signatory Authority Title <br />(printed) <br />Signature of Authorized Individual Date <br />Approved for Payment by: <br />Commission Project Manager Gate <br />Rev. 12/99 <br />