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

Applicant Harrison County
Cash Summary Support Sheet
Request No: 3
Page 20f2
R-103-06
R-103-024-03-KE D
4. Activity: Construction of Public Building (a)
,
(b)
A.
B.
C.
D.
Une Item Vendor Name Invoice # Invoice Amount Match Share Federal Share
Subtotal:
5. Activity: Contingencies (a) : (b)
Line Item Vendor Name Invoice # Invoice Amount Match Share Federal Share
A.
B.
C.
D.
Subtotal:
6. Activity: Renovation of Public Building (a) (b)
A.
B.
C.
D,
Une Item Vendor Name Invoice # Invoice Amount Match Share Federal Share
Subtotal:
Cumulative Match Expended To Date: GRAND TOTAL: 1$ 288,535,471 $ - 1$ 288,535.47
Cumulative Federal Expended To Date: $849,304.65
I hereby certify 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 Dr grant; b) the amount requested will be expended for allowable costs/expenditures under the terms of the contract agreement or grant;
c) the amounl requested herein does not exceed the total funds obligated by contract: and d) the funtil> are requested for only immediate disbursements.
I Hereby Certify tthat the goods sold and/or services rendered have been delivered and/or performed In good order and are in compliance wilh all statutory requirements
and regulations.
Marlin Ladner, President
Typed Name and Title of Authorized Official
• •
Signature ofAuthorized Official