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Attachment D <br />Request for Reimbursement of Funds <br />Prepare an itemized request for reimbursement expenditures in each budget category for each deliverable. Attach copies of purchase <br />orders and paid vouchers, invoices, copies of checks, journal transfers, and any other expenditure justifications which reflect the <br />deliverables provided during the reporting period. If there is insufficient space, please include details in an attachment. <br />Budget Categories <br />Project <br />Unit Price ($) <br />Request <br />I <br />Total Amount <br />Request <br />Previous <br />County: <br />Indian River <br />Name <br />PSAP Upgrade <br />Number:T <br />I Date: <br />Amount ($) <br />Budget Categories <br />Unit Price ($) <br />Quantity <br />Total Amount <br />Previous <br />Current Request <br />Deliverable Items <br />($) <br />Request <br />Amount ($) <br />Amount $ <br />A. Systems (Hardware, Software, <br />Equipment & Labor) <br />B. Services (i.e. Training, Maintenance <br />and Warranty Items) <br />Reimbursement Request Total <br />Approximate amount of funding available (Percentage) % <br />Documentation Received <br />Signature of Authorized Official <br />Date <br />DMS -P1-25-07-17 Page 1 of 2 <br />�na <br />ym� <br />r- -nrn <br />t!]nn <br />D <br />rn0� <br />zZ <br />0 <br />0Z <br />rs <br />m <br />�CA <br />b <br />M <br />