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F-1 <br />4D <br />ATTACHMENT S <br />FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION <br />FLORIDA BEACH EROSION CONTROL PROGRAM <br />REQUEST FOR PAYMENT ^ PART I <br />Name of Project: Ambersand/ Wabasso Beach Restoration <br />Grantee: Indian River County_ DEP Contract Number: 98IR1 <br />Billing Number: Billing Period: <br />Costs Incurred This Payment Request <br />Contractual <br />Cost Summary <br />State Funds Obligated <br />Less Previous Payment <br />Less This Payment <br />Less Retainage (10%) <br />Less Previous Retained <br />State Funds Remaining <br />I.173,208 <br />Local Funds Obligated <br />Less Previous Credits <br />Less This Credit <br />Local Funds Remaining <br />1.092.63 <br />Certisication: I certify that this billing is correct and is based upon actual <br />obligations of record by the grantee; that payment from the State Government has not been <br />received; that the work and/or services are in accordance with the Department of <br />Environmental Protection, Bureau of Beaches and Coastal System's approved Project <br />Agreement including any amendments thereto; and that progress of the work and/or services <br />are satisfactory and are consistent with the amount billed. <br />Name of Project Administrator Signature of Project Administrator Date <br />Name of Project Financial Officer Signature of Project Financial officer Date <br />Attachment H, DEP Project Agreement No. 98IRI, Amendment No. 3, Page 1 of"2 <br />