Laserfiche WebLink
ATTACHMENT D -I <br />FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION <br />BEACH MANAGEMENT FUNDING ASSISTANCE PROGRAM <br />REQUEST FOR PAYMENT — PART I <br />PAYMENT SUMMARY <br />Name of Project: AMBERSAND BEACH NOURISHMENT <br />Grantee: INDIAN RIVER COUNTY <br />Billing Number: <br />Costs Incurred This Payment Request: <br />Federal Share* State Share <br />*if applicable <br />Cost Summary: <br />State Funds Obligated <br />Less Advance Pay <br />Less Previous Payment <br />Less Previous Retained <br />Less This Payment <br />Less This Retainage (10%) <br />State Funds Remaining <br />DEP Contract Number: 07IR3 <br />Billing Period: <br />Billing Type: ❑ Interim Billing ❑ Final Billing <br />Local Share <br />P <br />Total <br />U <br />Local Funds Obligated $ <br />Less Advance Pay <br />Less Previous Credits $ <br />Less This Credit $ <br />Local Funds Remaining $ <br />Certification: I certify that this billing is correct and is based upon actual obligations of record by the grantee; that <br />payment from the State Government has not been received; that the work and/or services are in accordance with the <br />Department of Environmental Protection, Bureau of Beaches and Coastal Systems approved Project Agreement including <br />any amendments thereto; and that progress of the work and/or services are satisfactory and are consistent with the amount <br />billed. <br />Name of Project Administrator <br />Signature of Project Administrator <br />Name of Project Financial Officer Signature of Project Financial Officer <br />Date <br />Date <br />DEP Agreement No. 07IR3, Amendment No. 1, Attachment D-1, Page 1 of 3 <br />