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FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION <br /> 2004 HURRICANE RECOVERY PLAN GRANT PROGRAM <br /> REQUEST FOR PAYMENT — PART II <br /> REIMBURSEMENT DETAIL <br /> Name of Project : INDIAN RIVER COUNTY DUNE RESTORATION PROJECT <br /> Grantee : INDIAN RIVER COUNTY DEP Contract Number: H5IR1 <br /> Billing Number: Billing Period: <br /> Summary of Invoices : <br /> Task <br /> Date of Invoice Amount of No ./ Check Amount Paid <br /> Invoice Number Invoice (Eligible Vendor Name Number Vendor <br /> Project <br /> Item) <br /> TOTAL : $ <br /> Certification: I certify that the purchases noted above were used in accomplishing the project; and that invoices, check vouchers, <br /> copies of checks, and other purchasing documentation attached hereto are maintained as required to support the cost reported above <br /> and are available for audit upon request. <br /> Name of Project Administrator Signature of Project Administrator Date <br /> Name of Project Financial Officer Signature of Project Financial Officer Date <br /> Attachment E. DEP Agreement No . 1-15IR1 , Page 2 of <br />