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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 <br />Billing Number: <br />Costs Incurred This Payment Requests <br />Federal Share", <br />g <br />cif 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 />State Share <br />DEP Contract Number: 07LR2 <br />Billing Period: <br />Billing Type: ❑ Interim Billing <br />Local Share Total <br />S <br />S <br />g <br />S <br />S <br />5 <br />S <br />Local Funds Obligated <br />Less Advance Pay <br />Less Previous Credits <br />Less This Credit <br />Local Funds Remaining <br />❑ Final Billing <br />0 <br />S <br />g <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 />Name of Project Financial Officer <br />Signature of Project Administrator Date <br />Signature of Project Financial Officer Date <br />DEP Agreement No. 07IR2, Attachment C, Page ] of 3 <br />i <br />