minutes board of supervisors, harrison county, mississippi minute ...

Cash Summary Support Sheet Page 2 of 2
Applicant Harrison Countx Request No: 3 Grant Number: R-103-06
Contract Number: R-109-Q24-03-KCR
4. Activity: Construction of Public Building (a) : (b)
A.
B.
C.
D.
Line Item Vendor Name Invoice # Invoice Amount Match Share Federal Share
Subtotal:
5. Activity: Contingency (a) : (b)
A.
B.
C.
D.
Line Item Vendor Name lnvoice # 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$ 14,350.56 I$ - 1$ 14,350,561
Cumulative Federal Expended To Date: $52,191.22
I hereby Certify That: a) the servIces covered by this request have not been received from the Federal GOllElmment or expended for such services under any other
contract agream ent or grant; b) the amount req uested will be expended fo r allowab Ie costs/expenditures under the te rms of the contract agreem eI'll or grant;
c) the amount requested herein does not exceed the tolal funds obligated by contract; and d) the fuMS are requested for only Immediate disbursements.
I Hereby Certify tthal the goods sold and/or services rertdered have bean delivered andJor performed In good order and are in compliance with all statutory requIrements
and regUlations.
Marlin Ladner, President
Typed Name and Title of Authorized Official
•
Signature of Authorized Official
-