HomeMy WebLinkAboutExhibit 15ATTACHMENT B
Disbursement Request Package
Legislative Projects (LP) Grants
1. Grantee/Recipient CITY OF MIAMI
2. Project Number LP6056 Date of Request
3, Disbursement Request Number Required Match %
4. Type of Request: Partial ❑ Final ❑
5, Federal Employer Identification Number
6, Mail ❑ EFT ❑ Send Remittance to:
Disbursement Details
(cumulative amounts rounded to the nearest dollar)
1. Planning (attach invoices)
2. Engineering (attach invoices)
3. Construction and Demolition (attach invoices)
4. Technical Services during Construction (attach invorces)
5. Other (list - must be specified in agreement)
6. Total cumulative to date
7. Disbursements previously requested
8. Amount requested for disbursement (line 6 minus line 7)
Requests for Invoices already Paid:
1) Copy of Invoice
2) Proof of Payment
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Requests for Invoices not yet Paid:
1) Copy of Invoice
2) Advance Payment Justification (one per quarter)
3) Advance Payment — Interest Earned (after initial advance)
*If prior Disbursement Request was requested by invoices without proof of payment documentation, proof of the
prior payment will be required before this request can be disbursed.
** SUBMIT ONE ORIGINAL COPY OF THIS FORM AND SUPPORTING DOCUMENTATION TO: **
Florida Department of Environmental Protection
Bureau of Water Facilities Funding MS 3505
2600 Blair Stone Road
Tallahassee, Florida 32399-2400
DEP Agreement No. LP6056, Attachment B, Page 1 of 3