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\ 1 STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION 725-040.29
Y AVIATION GRANT PROGRAM AVIATION
�1 PROJECT INVOICE FORM to
INSTRUCTIONS: This form will be submitted in addition to the normal sponsor Invoice submission documentation.
Recipient Name:
City of Sebastian
Bill To:
Florida Department of Transportation
Project Phases
Land Acquisition
Planning
Address:
1225 Main Street
City, State, Zip:
Sebastian,FL 32958
Invoice No.: 13 FM Number: 442004-1-94-01
03/16/22 to
Invoice Period: 07/31/22 FM Number:
Contract No.: G1451 Allowable Cost Incurred: 2,083,871.29
Amendment No.:
FDOT Grant / Match Amount:
1,667,097.03
Project:
Construct Hangar
Total FDOT Grant
Total Previous
Current Invoice
Remaining FOOT
Amount by Project
Amount Paid for
Amount Requested
Grant Balance
Phase
FDOT Grant
for FDOT Grant
$
$
$
$ 0.00
$
S
$
$ 0.001
Environmental/Design/Construction
$1,800,000.00
$1,481,954.39
$185,142.64
$132,902.97
Capital Equipment
$
$
$
$ 0.00
Match to Direct Federal Funding
$
$
$
$ 0.00
$
$
$
$ 0.00
$
$
$
$ 0.00
Totals:
$1,800,000.00
$1,481,954.39
$185,142.64
$132,902.97
Note: The cost and amounts shown on
this invoice form are reflective of the values shown in the Agreement, Exhibit
"S" Schedule of Financial Assistance.
AIRPORT SPONSOR (AGENCY) OR DESIGNATED REPRESENTATIVE
I certify that the information provided above is true and correct per the terms of the Public Transportation Grant Agreement.
Jeffrey Sabo
Airport Sponsor Representative Printed Name'
Signature
Airport Manager
Title
Date
U 4�'Z-z
Only the Airport Sponsor or Designated Representative may sign this form. A non -Airport Sponsor employee (e.g., consultant) cannot sign this form.
For information regarding this invoice, please contact (Name, Phone NO.):
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