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Required Signatures: Adobe Signature <br />Date: <br />Grantee <br />Billing Period: <br />STATE OF FLORIDA <br />INDIAN RIVER COUNTY <br />THIS IS TO CERTIFY THAT THIS IS A TRUE AND CORRECT <br />COPY OF THE ORIGINAL ON FEE IN THIS OFFICE. <br />RYAN L. BUTLER, CLERK <br />Florida Department of Environmenla&tio— <br />DATE la <br />EXHIBIT C <br />PAYMENT REQUEST SUMMARY FORM <br />Project Name and Number <br />Billing #: <br />DEP Division: DEP Program: <br />CERTIFICATION: I hereby certify that the above expenses were incurred for the work being <br />accomplished in the attached progress reports. <br />Project Administrator <br />Date <br />CERTIFICATION: I hereby certify that the documentation has been maintained as required to support the <br />project expenses as reported above and is available for audit upon request. <br />Project Financial Officer <br />Date <br />DRP -115 (Effective 06-19-2015) Page 1 of l <br />Proie+ct Costs This Billiiig <br />Cumulative Project Cuts <br />Contractual Services <br />DRP -116 <br />Grantee Labor <br />DRP -117 <br />Employee Benefits <br />( % of Salaries) <br />Direct Purchases: Materials & Supplies <br />DRP -118 <br />Grantee Stock <br />DRP -120 <br />Equipment <br />DRP -119 <br />Land Value <br />Indirect Costs <br />(15% of Grantee Labor) <br />TOTAL PROJECT COSTS J$0.00- <br />Isom <br />CERTIFICATION: I hereby certify that the above expenses were incurred for the work being <br />accomplished in the attached progress reports. <br />Project Administrator <br />Date <br />CERTIFICATION: I hereby certify that the documentation has been maintained as required to support the <br />project expenses as reported above and is available for audit upon request. <br />Project Financial Officer <br />Date <br />DRP -115 (Effective 06-19-2015) Page 1 of l <br />