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Attachment D <br />FINANCIAL INVOICE FORM <br />FOR <br />HAZARDOUS MATERIALS HAZARDS ANALYSIS UPDATE <br />RECIPIENT: Indian River County AGREEMENT#16-CP-11-10-40-01-174 <br />AMOUNT AMOUNT APPROVED <br />REQUESTED BY THE <br />BY THE RECIPIENT DIVISION <br />1. First Payment (45% of contract amount) $ $ <br />(50% Hazards Analyses submitted and approved) <br />2. Second Payment (45% of contract amount) $ $ <br />(50% Hazards Analyses submitted and approved) <br />3. Final Payment(10% of contract amount) $ $ <br />(approval, distribution & notification) <br />TOTAL AMOUNT $ $ <br />(To be completed by <br />the Division) <br />I certify that to the best of my knowledge and belief the billed costs are in accordance with the <br />terms of the Agreement. <br />Signature of Authorized Official/Title <br />Date <br />TOTAL AMOUNT TO BE PAID AS OF <br />THIS INVOICE $ <br />(To be completed by the Division) <br />23 <br />