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HomeMy WebLinkAbout995-Roosevelt & 19th Sewer Ext SEMINOLE COUNTY/CITY OF SANFOP. D INFRASTRUCTURE I~ROVEbIENTS HUD/CDBG SUBRECIPIENT AGREEMENT PROGRAM YEAR 2003-2004 THIS AGREEMENT, entered into this ~ ~ day of ~p/. , 2003, by and between SEMINOLE COUNTY, a political subdivision of the State of Florida, whose address is 1101 East First Street, Sanford, Florida 32771, hereinafter referred to as "COUNTY," and CITY OF SANFORD, whose mailing address is P.O. 1788, hereinafter referred to as WHEREAS, COUNTY has made contract with the United States a political subdivision of the State of Florida, Florida, 32772- Box 1788, Sanford, "SANFORD". application and entered into a Department of Housing and Urban pursuant to Title as amended, and Code of Federal sanitary sewer and that such services will serve Development, hereinafter referred to as "HUD," I, Housing and Community Development Act of 1974, implementing regulations set forth in Title 24 Regulations (CFR) Section 570; and WHEREAS, SANFOPJD shall construct and improve systems and provide street repair and resurfacing; WHEREAS, the COUNTY has deemed has of HUD/CDBG funds a COUNTY purpose; and WHEREAS, the COUlXTTY THOUSAND, SEVEN HU1XTDRED ($409,726.00) allocated FOUR HUNDRED AND NINE TWENTY-SIX AND N0/100 DOLLARS for such improvements; and to financially leverage certain the COUNTY pursuant to this 1 COPY MORSE Ci[,~C UIT COURT C~UNTY. FLORIDA WHEREAS, SANFORD has agreed funds provided by HUD through Agreement, NOW, THEREFORE, in consideration of the mutual covenants, promises and representations contained herein and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows: Section 1. Recitals. The above recitals are true and form a material part of the Agreement upon which the parties have relied. Section 2. Definitions. (a) ~Affordability Period" means the length of time for which the subject properties must comply with HUD regulations. (b) "CD Administrator" means the Community Resources Division Manager or their designee. (c) "County Approval" means Planning and Development Director, Manager, or their designee. (d) "Low and Moderate Income" not to exceed eighty percent (80%) within the Orlando Metropolitan of this Agreement. (e) "Planning Department" Development Department Director Development Office. (f) "Very low exceed fifty percent Orlando Metropolitan Agreement. written approval by the Community Resources Division means gross household income of the median family income Statistical Area during the term means the COUlqTY's Planning and or his designee for the Community income" means gross household income not to (50%) of the median family income within the Statistical Area during the term of this 2 Section 3. Statement of Work. SANFORD, in a manner satisfactory to the COUNTY, shall perform all services described in the Scope of Services, attached hereto as Exhibit A and incorporated herein by reference. Such services shall be performed, except as otherwise specifically stated herein, by persons or instrumentalities solely under the dominion and control of SANFORD. Section ~. Term. execution by all parties. SANFORD shall complete required by this Agreement on or before December 31, This Agreement shall be effective upon its all services 2004. Section 5. Payments. (a) The COUNTY shall administration costs and subcontractors and vendors under this Agreement in reimburse SANFORD for its for funds paid to the contractors, selected by SANFOPdD to provide services accordance with the Project Budget, attached hereto as Exhibit B and incorporated herein by reference. (b) The COUNTY has allocated FOUR HUNDRED AND NINE THOUSAND, SEVEN HUNDRED AND TWENTY-SIX AND NO/100 DOLLARS ($409,726.00) of HUD funds for completion of this Agreement. The COUNTY will reimburse SANFORD for the services rendered under this Agreement up to FOUR HUNDRED AND NINE THOUSAND, SEVEN HUNDRED AND TWENTY-SIX AND NO/100 DOLLARS ($409,726.00). In the event that SANFORD does not require the full amount of FOUR HUNDRED AND NINE THOUSAND, SEVEN HUNDRED AND TWENTY-SIX DOLLARS AND NO/100 ($409,726.00), as reflected in the bids received and reviewed by 3 both parties to this Agreement, the CD Administrator the right to reallocate such funds to other HUD projects. (c) In no event shall the COUNTY reimburse SANFORD, its contractors, subcontractors or vendors until all goods and reserves services rendered are invoiced and approved in writing by the City Manager of SANFORD and the CD Administrator. (d) In order to process payment requests, SANFORD shall submit to the COUNTY an original invoice signed by the entity requesting payment and SANFORD'S Project Manager. Copies of receipts or other acceptable documentation demonstrating incurrence of each expense must be submitted with the invoice. (e) Upon receipt of the documentation listed above, the COUNTY shall initiate reimbursement to the requesting entity. The COUNTY reserves the right to verify, by site inspection when necessary, that all goods, materials, labor and services have been properly invoiced. Payment shall be made as soon as practicable; provided, however, that if SANFORD, its vendors, contractors and subcontractors have performed services in full compliance with all HUD requirements and properly invoiced the request for payment, payment shall be rendered by the COUNTY within thirty (30) days of its receipt of payment request. (f) On or before November 30, 2004, SANFORD shall render a final and complete statement to the COUNTY of all costs for goods and services not previously invoiced. The COUNTY shall not be 4 obligated to pay any charges, claims or demands of SANFORD not properly invoiced and received by the COUNTY by November 30, 2004. (g) Amy goods or services not allotted in the Project Budget, or not undertaken in compliance with this Agreement, will only be reimbursed by the COUNTY if the CD Administrator has issued prior written approval of such goods or services. (h) SANFORD shall use the funds provided under this Agreement to leverage funds and services of a value of at least ONE HUNDRED AND FIFTEEN THOUSAND AND NO/100 DOLLARS ($115,000.00) toward the completion of the services described herein. Such leveraged funds may be received Transportation and/or Florida Protection or any other available from the Florida Department of Department of Environmental source. Prior to final payment by the COUNTY, demonstrate that leveraged. purchase, benefits SANFORD shall provide appropriate documentation to sufficient funds and or services have been SANFORD shall not be reimbursed for any acquisition, donation or receipt of any interest in real property or by a real property owner of any real property unless SANFORD has first received written authorization from the CD Administrator. The acquisition, purchase, donation or receipt of any interest in real property or benefits by a real property owner of any real property by SANFORD shall automatically termi- nate this Agreement. Section 6. Compliance With Federal Regulations. (a) SANFOPJD shall comply with all federal, State and local laws and regulations in its performance of this Agreement. It is understood that the following are laws and regulations which will directly govern implementation of this Agreement: (1) Title 24, Code of Federal Regulations, "Regulations Relating to Housing and Urban Development." (2) Public Law 90-284, ~1968 Civil Rights Act of 1968"; (3) Public Law 90-448, "Housing and Urban Development Act of 1968"; (4) 42 USCA Chapter 51, ~Design and Construction of Public Buildings to Accommodate Physically Handicapped"; (5) Office of Management and Budget Circular No. A- ll0, ~Uniform Administrative Requirements For Grants and Agree- ments With Institutions Of Higher Education, Hospitals and Other Non Profit Organizations"; (6) Office of Management and Budget Circular No. A-122, ~Cost Principles For Non-Profit Organizations"- (7) Office of Management and Budget Circular No. A- 102, ~Grants and Cooperative Agreements with State and Local Governments"; ~Cost (8) Office of Management and Budget Circular No. A-87, Principles for State, Local, and Indian Tribal Governments"; (c) SANFORD shall not assume the COUNTY' s enviroD-mental responsibilities, as described in 24 CFR Sec. 570. 604 ~Environmental Standards", nor the COUNTY's responsibility to initiate and environmental review process. However, SANFORD is not exempt from performing site-specific environmental reviews in accordance with State and local regulations. Nor is SANFORD released from any environmental pollution that it may cause or have caused and SANFORD shall assume full liability therefore. Section 7. Project Publicity. Any news release, project sign, or other type of publicity pertaining to the project, described herein shall recognize the Seminole County Board of County Commissioners as the recipient of funding by HUD and providing funds to SANFORD. Section 8. ManaHement Assistance. (a) The CD Administrator shall be available to SANFORD to provide guidance on HUD requirements. (b) In the event that SANFORD does not complete any of the terms of this Agreement within the time frames allotted herein, COUNTY may provide notices to SANFORD on the sixth month and/or the ninth month after the expiration of the subject time frame advising SANFORD that it is in default of the Agreement and the pending consequences thereof. Nothing set forth herein however, shall prohibit the COUNTY from taking any action prior to such dates to enforce the terms of this Agreement. 7 Section 9. Maintenance of Records. (a) SANFORD shall maintain all records required by Federal, State and local laws, rules and regulations for a period of no less than five years from the date of the final project audit. This requirement shall include: (1) Ail accounts, property and personnel records, as deemed necessary by the COUNTY to ensure proper accounting of all project funds and compliance with this Agreement. all (2) Financial records regarding the following: (A) Invoices, receipts items purchased by SANFORD pursuant (B) Bills and invoices by SANFORD pursuant to this Agreement; (c) records indicating labor costs. and cancelled checks of to this Agreement; for all services purchased Force account construction including the SANFORD, position, number of hours and total (D) Ail capital expenditures in excess of SEVEN AND NO/100 DOLLARS ($750.00), including a serial number and date and cost of HUNDRED FIFTY description, model, acquisition. (b) SANFORD annual audit and performed an Administrator within thirty (30) SANFORD is receiving more than DOLLARS ($300,000.00) CD If THREE HUNDRED THOUSAND AND NO/100 from HUD through the COUNTY pursuant to this shall perform or cause to be provide copies of such audits to the days of its completion. Agreement, such auditing procedures shall be undertaken in compliance with Management and Budget Circular A-133 and provided to the CD Administrator in a timely manner. (c) Ail records and contracts, of whatsoever t!rpe or nature, required by the Agreement shall be available for audit, inspection and copying in accordance with Chapter 119, Florida Statutes. The COUNTY shall have the right to obtain and inspect any audit or other documents pertaining to the performance of the Agreement made by any Federal, State or local agency. (d) SANFORD shall complete and provide to the CD Administrator a monthly report on the Subrecipient Report attached hereto as Exhibit C. Such reports shall be due no later than the fifteenth (15~h) day of each month, commencing on the date of execution of this Agreement and concluding upon the completion of all services described in Exhibit A. (e) SANFORD shall submit to the COUNTY an End of Project Report attached hereto as Exhibit D. Liability. Except for any payment specifically the COUNTY shall not be liable to any person, corporation in connection with the services agreed to perform hereunder, or for debts or claims such parties against SANFORD. This Agreement shall contractual relationship, either express or implied, other person, firm, or corporation services, goods or materials to SANFORD Section set forth herein, firm, entity or SANFORD has accruing to not create a between COUNTY and any supplying any work, labor, 9 as a result of this Agreement, subcontractors and vendors who may by SANFORD. Section 11. Subcontracts. perform the activities described all applicable laws, rules and including the contractors, from time-to-time be employed Ail contracts made by SANFORD to in Exhibit A shall comply with regulations set forth in the Agreement. Only subcontracts for work or services as set forth in Exhibit A are authorized by this Agreement. Any further work or services which SAN-FORD wishes to subcontract must be approved in writing by the CD Administrator and may not exceed the financial restraints forth in Section 5 of this Agreement. Section 12. Indemnification. (a) SANFORD shall hold harmless and indemnify the COUNTY from and against any and all liability, loss, claims, damages, costs, attorney's fees and expenses of whatsoever kind, type, or nature which the COUNTY may sustain, suffer or incur or be required to pay by reason of the following: loss of any monies paid to SANFORD or whomsoever, resulting out of SANFORD'S fraud, defalcation, dishonesty, or failure of SANFORD to comply with applicable laws or regulations; any act or omission of SANFORD in the performance of this Agreement or any part thereof; a judgment over and above the limits provided by the insurance required hereunder or by any defect in the construction of the project; or as may otherwise result in any way or instance whatsoever arising from this Agreement. 10 (b) In the event that any action, suit or proceeding is brought against the COUNTY upon any alleged liability arising out of the Agreement, or any other matter relating to this Agreement, the COUNTY shall promptly provide notice in writing thereof to SANFORD by registered or certified mail addressed to SANFORD at the address provided hereinafter. Upon receiving such notice, SANFORD, at its own expense and to the extent permitted by law, shall diligently defend against such action, suit or proceeding and take all action necessary or proper to prevent the issuance of a judgment against the COUNTY. The COUNTY shall cooperate to a reasonable extent in SANFORD'S defense of any such action, suit or proceeding. Section 13. Insurance. SANFORD shall ensure that its insurance coverage or self-insurance program, and the insurance coverage of its contracted agents, conforms to and complies with all applicable Federal, State and local regulations and is adequate and sufficient to insure all activities performed pursuant to the Agreement against property damage or loss, human injury and other casualty. Section 14. Non-Assignability. Neither party shall assign the Agreement without the prior written consent of the other in a document of equal dignity herewith. Section 15. Headings. Ail articles and descriptive headings of paragraphs in this Agreement are inserted for convenience only and shall not affect the construction or interpretation hereof. 11 Section 16. Income. (a) In the event that any income a direct result of the investment of any COUNTY funds under this Agreement during the term of the Agreement, shall immediately render such income to the COUNTY. (b) If any income is received by SANFORD as a direct result of the investment of any COUNTY funds awarded under this Agreement after expiration of the term of this Agreement, such income shall be used by SANFORD to provide services to the clients of SANFORD of a nature similar to the uses set forth herein. Section 17. Non-Exl~endable Property. Any non-expendable personal property acquired by SANFORD through funds issued by the COUNTY pursuant to this Agreement shall be subject to all Federal, State and local regulations, including, but not limited to, the provisions on use and disposition of property. At the termination of this Agreement, any such property shall be made available to the COUNTY and HUD in accordance with the aforesaid provisions. Section 18. Reversion of Assets. Upon expiration of this Agreement, SANFORD shall immediately transfer to the COUNTY remaining HUD funds the use of HUD funds distribution of any acquired or improved excess of TWENTY-FIVE is received by SANFORD as awarded SANFORD any to The real property controlled by SANFORD and in whole, or in part, with HUD funds in THOUSAND AND NO/100 DOLLARS ($25,000.00) shall be governed by 24 CFR Sections 570.505 12 and 570.503. and any accounts receivable attributable distributed pursuant to this Agreement. Section 19. SusDension and Termination. COUNTY may terminate this Agreement in accordance with the provisions of 24 CFR Section 84.61, for breach of the Agreement or for other legal cause. The parties may mutually terminate the Agreement in accordance with 24 CFR Section 85.44 or for other legal cause. Section 20. Breach. Services or other terms breach of this Agreement. Section 21. Remedies. Any failure to comply with the Scope of of this Agreement shall constitute a Upon determination that a breach has occurred, the COUNTY reserves all legal and equitable rights to enforce this Agreement and/or recover any monies paid to SANFORD pursuant to this Agreement. Specifically and additionally, the COUNTY shall have the following available remedies: (a) Immediately terminate the Agreement, with or without notice; (b) Reallocate the remaining uncommitted funds toward another HUD program or toward the COUNTY's trust fund; (c) Withhold issuance of any further funds, regardless of whether such funds have been encumbered by SANFORD; (d) Demand SANFORD immediately repay any monies expended in accordance with the Agreement; (e) Require specific performance of the Agreement; {f) Demand payment and/or performance from the surety, if applicable; and/or 13 (g) Impose a lien upon any and all of SANFORD'S real or personal property. To create such a lien, the COUNTY shall send a letter to SANFORD demanding refund of any monies expended to SANFORD pursuant to this Agreement. Said letter shall be recorded in the public records of Seminole County and thereafter shall constitute a lien upon SANFORD'S real and personal property. Section 22. Certification Regarding Lobbying. SANFORD hereby certifies that to the best of its knowledge and belief: (a) No federally appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence any officer or employee of any agency, a member of Congress, an officer or employee of Congress, or an employee of a member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan or cooperative agreement. (b) If any funds other than federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence any officer or employee of any agency, a member of Congress, an officer or employee of Congress, or any employee of a member of Congress in connection with this Agreement, SANFORD shall complete and submit a "Disclosure of 14 Lobbying Activities" standard Management and Budget. (c) Pursuant to Section form as approved by the Office of 216.347, Florida Statutes, SANFORD hereby agrees that monies received from the COUNTY pursuant to the Agreement will not be used for the purpose of lobbying the Legislature, the judicial branch or a State agency. Section 23. Notice. Whenever either party desires to give notice unto the other, For COUNTY: CD Administrator Community Development Office 1101 East First Street Sanford, Florida 32771 For SANFORD: City Manager City of Sanford Post Office Box 1788 Sanford, Florida 32772-1788 Either of the parties may change, or person for receipt of notice. Section 24. Conflict of Interest. (a) SANFORD agrees that it will that would create a conflict obligations pursuant to the notice may be sent to: by written notice, the address not engage in any action of interest in the performance of its Agreement with the COUNTY or which would violate or III, Chapter 112, (b) SANFORD employee cause others to violate the provisions of Part Florida Statutes. hereby certifies that no officer, agent or of the COUNTY has any material interest, as defined in 15 Section indirectly, in shall have any Agreement. Section 25. This instrument 112.312(15), Florida the business of such interest at Statutes, either directly or SANFORD, and that no such person any time during the term of the Entire Agreement, Effect on Prior Agreement. constitutes the entire agreement between the parties and supersedes all previous discussions, understandings and agreements, if any, between the parties relating to the subject matter of this Agreement. Section 26. Severability. If any one or more of the covenants or provisions of this Agreement shall be held to be contrary to any express provision of law or contrary to the policy of express law, though not expressly prohibited, or against public policy, or shall, for any reason whatsoever, be held invalid, then such covenants or provisions shall be null and void, shall be deemed separable from the remaining covenants or provisions Agreement, and shall, in no way, affect the validity remaining covenants or provisions of the Agreement. IN WITNESS WHEREOF, the parties hereto have caused Agreement to be executed: ATTEST: CITY OF SANFORD ~ ~3~NET R. DOUG~L~RTY g BRADY M. LES~ARD, Mayor of the of the the 16 ATTEST: ~ClerK tm the Board of County Commissioners of Seminole County, Florida. For the use and reliance of Seminole County only. Approved as to form and lega~ sufficiency. County-~t~orney - BOARD OF COUNTY COMMISSIONERS SEMINOLE ~O~Y,., FLORIDA By: E~M~L'AiN, Chai rman Date: ~'~-~ As authorized for execution by the Board of County ~Commis- sioners at their ~2~7~, , 2003 regular meeting. KC/gn 7/24/03 Attachments: 1. Exhibit A - Scope of Services 2. Exhibit B - Project Budget 3. Exhibit C - Subrecipient Report 4. Exhibit D - End of Project Report C~KC01\MYDOCS\Affordable Housing\sanford street agreement.doc 17 EXHIBIT A SCOPE OF SERVICES GENERALLY: SANFORD shall construct and improve sanitary sewer systems, street repair and resurfacing, and associated construction work in the area of Sanford known as Goldsboro, as depicted on Attach- ment 1. Such work shall be undertaken in compliance with the specifications set forth in Attactunent 2. SPECIFIC OBLIGATIONS: 1. SANFORD shall prepare all legal documents required for bidding in accordance with legal requirements. The documents shall be submitted to COUNTY for review and approval prior to commencement of the bidding process. 2. SANFORD shall advertise for bids and provide bidding contractors a specific response period in accordance with legal requirements. 3. Following the close of the bidding period, the COUNTY and SANFORD shall jointly review the bids received and contractor qualifications. SANFORD shall select, upon COUNTY approval, the contractor to be awarded the construction work. SANFORD shall prepare and negotiate a contract with the selected contractor and make an appropriate bid and contract award. 4. SANFORD and the COUNTY shall hold conference with the contractor, subcontractor, representatives, city representatives and persons for the purpose of: a pre-construction private utilities other appropriate (a) Identifying the SAIqFOPdD project manager; (b) Identifying the contractor's project manager; (c) Identifying the field monitors; (d) Discussing the plans and specifications; (e) Discussing construction procedures and scheduling; (f) Answering any questions prior to construction; and (g) Discussing Federal requirements and regulations. 5. SANFORD shall monitor and inspect all construction ac- tivities to ensure compliance with this Agreement. SANFORD shall secure any necessary permits or certifi- The SANFORD project manager shall be the liaison to the and responsible for responding to all request by the cates. 7. COUNTY COUNTY. 8. SANFORD shall not acquire nor negotiate the purchase, donation or receipt of benefits by a real property owner of any real property or any interest in real property without first seeking consultation with the COUNTY. 2 ATTACHMENT 2 EXHIBIT A CITY OF SANFORD ROOSEVELT AVE. / 19TH ST. SANITARY SEWER AND LIFT STATION PHASE II CPH PROJECT NO. S0650.01 6/3012003 OPINION OF PROBABLE CONSTRUCTION COST TEM NO. DESCRIPTION UNIT QUANTITY UNIT PRICE TOTAL COST :1 Mobilization LS 1 $30,000 $30,000 2 Preconstn~ction Video LS 1 $2,000 $2,000 3 Maintenance of Traffic LS 1 $8,000 $8,000 4 Erosion and Sediment Control LS 1 $5,000 $5,000, '5 Staked Silt Fence Along Existing Stormwater Pond LF 466 $2.00 $932 6 Clearing and Grubbing LS 1 $5,000 $5,000 7 Restoration LS 1 $5,000 $5,000: 8 12" Stabilized Subbase SY 3339.0 $7.00 $23,373 i 9 B" Limerock Base Course SY 3222.1 $15.00 $48,332 10 Remove and Replace 12" Stabilized Shell Road SY 773.2 $9.00 $6,959 11 Remove Existing Pavement SY 3115.4 $5.00 $15,577 12 Type S Asphaltic Concrete (1.75") SY 3222.1 $13.00 $41,887 13 Remove and Replace Concrete Ddveway SY 29.4 $30 $882 14 Curb and Gutter (Remove and Replace) LF 18 $25 $450 15 Remove and Reinstall Existing Chain Link Fence LS 1 $500 $500 i16 Type 'B' Fence and Posts at Lift Station Site LF 85 $15 $1,275 117 Double Swing Gate at Lift Station Site (12' Opening) EA 1 $900 $900 i18 Seed and Mulch SY 1664.2 $0.50 $832 :19 Sodding (Bahia) SY 3220.9 $2.00 $6,442 i20 Lift Station LS I $150,000 $150,000 21 Fittings (DI) (F&I) 6" FM TN 0.20 $7,000 $1,400 ~22 8" PVC Sanitary Sewer (4'-6') LF 380 $24 $9,120 23 8" PVC Sanitary Sewer (6'-8') LF 1091 $27 $29,457 24 I" PVC Sanitary Sewer (8'~10') LF 1251 $32 $40,032 25 ~" PVC Sanitary Sewer ( 10'-12') LF 40 $37 $1,480 26 i" PVC Sewer Force Main (Outside Lift Station Site) LF 410 $16 $6,560 27 Sanitary Sewer Lateral (6" PVC) LF 500 $25 $12,500 28 Utility Manhole (F&I) Standard (3' - 6') EA 4 $1,800 $7,200 29 Utility Manhole (F&I) Standard (6' - 8') EA 4 $2,100 $8,400 30 Utility Manhole (F&l) Standard (8' - 10') EA 2 $2,500 $5,000 !31 Utility Manhole (F&I) Standard (10' ~ 12') EA 4 $3,300 $13,200 i32 Install Liner at Existing Manhole LS 1 $4,000 $4,000 33 6" Plug Valve EA I $750 $750 !34 Connect to Existing Sewer Manhole EA 1 $1,200 $1,200 35 ~ewer Service (Single Service) EA 7 $300 $2,100 36 Sewer Service (Double Service) EA 10 $400 $4,000 SUB-TOTAL $499,740 5% Cont ngency $24,987 FOTAL $524,726 Opinion of Probable Const. Cost (6-30-03).xls 7/2/2003 12:57 PM EXHIBIT B PROJECT BUDGET Activity Budget Reimbursement for the administration and con- $409,726.00 struction of improvements to sanitary sewer systems, street repair and resurfacing, and associated construction work. 1 EXHIBIT C REQUEST FOR PAYMENT Subrecipient: City of Sanford Name of Activity/Project: Vendor Mailing Address: Vendor Contact Person: Vendor Telephone Number: Payment Request No: Subrecipient % of Work To Date This Invoice Agreement Completed Amount Billed Amount To Previously $ Date Billed Total Invoices Billed Attach a copy of all supDorting documentation for this Payment Request Estimated Project/Activity Completion Date: Subrecipient Agreement Required Completion Date: Submitted By: Signature: Title: Date: H