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THE SCHOOL BOARD OF MIAMI-DADE COUNTY, FLORIDA
PAYMENT REQUEST FOR CONTRACTED SERVICES
(This form to be used in lieu of an original approved invoice.)
TO: THE SCHOOL BOARD OF MIAMI•DADE COUNTY, FLORIDA, ACCOUNTS PAYABLE DEPARTMENT
FROM: Ms, Mercedes Toural, Chief Education Officer and Dept. Superintendent of Schools
Originator of RequestlTitle (Name Typed)
Education 9702
Location Name Location Number
I certify that services have been rendered on July 1, 2004 and
the following amount is due and payable to the Contractor in accordance with the Agreement duly
executed on the 15th day of April 2004
Purchase Order Number R02157833
Total Amount Due (Lump sum payment) $
Or
Partial Payment # i in the amount of $ 150,937.50
REQUIRED PAYMENT DOCUMENTATION:
o The original Agreement Form for Contracted Services (FM-2453) must be submitted with all
lump sum and first partial payments (Note that subsequent partial payments require a copy
of the Agreement form); and
o a signed and dated copy of the Accounts Payable Purchase Order; and
O original approved invoice or th ayment Request For Contracted Services form (FM-2454).
•.•.'Signature /
Contractor
Signature
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Date
Originator of Request Date
FM-2454 Rev. (07-99)
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THE SCHOOL BOARD OF M1AMI-DADE COUNTY, FLORIDA
PAYMENT REQUEST FOR CONTRACTED SERVICES
(This form to be used in lieu of an original approved invoice.)
TO: THE SCHOOL BOARD OF MIAMI-DADE COUNTY, FLORIDA, ACCOUNTS PAYABLE DEPARTMENT
FROM: Ms. Mercedes Toural, Chief Education Officer and Dept. Superintendent of Schools
Originator of Request/Title (Name Typed)
Education
Location Name Location Number
certify that services have been rendered on August 13, 2004 and
the following amount is due and payable to the Contractor in accordance with the Agreement duly
executed on the 15th day of April ' , 2004
Purchase Order Number R02157833
9702
Total Amount Due (Lump sum payment) $
Or
Partial Payment # 2 in the amount of $ 150,567.50
REQUIRED PAYMENT DOCUMENTATION:
a The original Agreement Form for Contracted Services (FM-2453) must be submitted with all
lump sum and first partial payments (Note that subsequent partial payments require a copy
of the Agreement form); and
o a signed and dated copy of the Accounts Payable Purchase Order; and
o original approved invoice or t ' Payment Request For Contracted Services form (FM-2454).
ir
•:; .,ignature
•.::� Originator of Request
tractor Date
Date
FM-2454 Rev. (07-99)