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ATTACHMENT C <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: WABASSO BEACH RESTORATION <br /> Grantee : INDIAN RIVER COUNTY DEP Contract Number: 07LR2 <br /> Billing Number: Billing Period ,• <br /> Billing Type : ❑ Interim Billing ❑ Final Billing <br /> Costs Incurred This Payment Request , <br /> Federal Share ," State Share Local Share Total <br /> cif applicable <br /> Cost Sunnmary ; <br /> State Funds Obligated S Local Funds Obligated $ <br /> Less Advance Pay S Less Advance Pay S <br /> Less Previous Payment $ Less Previous Credits <br /> Less Previous Retained $ <br /> Less This Payment S Less This Credit $ <br /> Less This Retainage ( 10%) 5 Local Funds Remaining $ <br /> State Funds Remaining S <br /> Certification : I certify that this billing is correct and is based upon actual obligations of record by the grantee; <br /> 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 Signature of Project Administrator Date <br /> Name of Project Financial Officer Signature of Project Financial Officer Date <br /> DEP Agreement No . 07IR2, Attachment C, Page ] of 3 <br /> i <br />