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Attachment G <br />Financial Invoice Form <br />2025-2026 Hazard Analysis Grant Agreement <br />Recipient: <br />Grant Agreement#: <br />Deliverable & Invoice Amounts <br /># <br />Minimum Performance Requirements <br />Budget amount <br />Amount requested by Sub - <br />per Deliverable <br />Recipient <br />No later than December 1, 2025, provide <br />completed CAMEO Data Manager files for 25% <br />40% of HA <br />1 <br />of facilities listed in Attachment H. <br />Agreement <br />$2.00 <br />Hazards Analysis submissions are reviewed and <br />Amount <br />must be approved before invoice is submitted. <br />No later than April 1, 2026, provide completed <br />CAMEO Data Manager files for 25% of <br />40% of HA <br />2 <br />facilities listed in Attachment H. <br />Agreement <br />$1.00 <br />Hazards Analysis submissions are reviewed and <br />Amount <br />must be approved before invoice is submitted. <br />No later than June 1, 2026, provide a copy of the <br />"approved" CAMEO Data Manager file to the LEPC, <br />20% of HA <br />3 <br />notify first responders and Attachment H facilities of <br />Agreement <br />$1.00 <br />the availability of HA information, and provide FDEM <br />Amount <br />with the notifications of transmittals. <br />Total Requested: <br />$0.00 <br />I certify to the best of my knowledge and belief the billed costs are in accordance with the <br />Terms and Conditions of the Hazards Analysis Agreement. <br />Printed Name and Title <br />Recipient Signature Date <br />27 RA Attachment I Financial Invoice Form 616/2022 <br />