minutes board of supervisors, harrison county, mississippi minute

Applicant Harrison County
Cash Summary Support Sheet
Request No: 9
Page 2 of 2
R-103-06
R-109-024-02-KCR
4. Activity: Construction of Public Building (a) : (b)
Line Item Vendor Name Invoice # Invoice Amount Match Share Federal Share
A.
B.
c.
D.
Subtotal:
5. Activity: Contingency (a)
,
(b)
A.
B.
c.
D.
Line Item Vendor Name Invoice # Invoice Amount Match Share Federal Share
Subtotal:
6. Activity: (a)
: (b)
A.
B.
C.
D.
Line Item Vendor Name Invoice # Invoice Amount Match Share Federal Share
Subtotal:
Cumulative Match Expended To Date: GRAND TOTAL: I $ 175,875.18 I $ . 1$ 175,875.18 I
Cumulative Federal Expended To Date: $384,988.82
I hereby CerUfy That: a) the services covered by this request have not been received from the Federal Government or expended for such services under any other
contract agreement or grant; b) the amount requested will be expended for allowable costs/expenditures under the terms of the contract agreement or grant;
c) the amount requested herein does not exceed the total funds obligated by contract; and d) the funds are requested for only immediate disbursements.
I Hereby Certify !that the goods sold and/or services rendered have been delivered and/or performed in good order and are." compliance with a~tory requirements
-. .
and regulations. , .
Marlin Ladner, President
Typed Name and Title of Authorized Official
•
$
=
. Signature 01 I"\,,!,horized Official