State Funded Progress Billing
Address
State Project Number: Progress Bill No:
Fed Tax ID No. Agreement Number: LA- Final Progress Bill?
Agency Use: Last Supplement : Billing Period from:
Project Title: through:
1 2 3 4 5 6 7 8
Total Total Participation Amount Claimed Amount Total Claimed Amount Remaining
Eligible Eligible Rate This Period Claimed To Date Authorized State Funds
PE This Period To Date Col 1 x Col 3 Prior Periods Col 4 + Col 5 Per Agreement Col 7 - Col 6
0.00 0.00 0.00
0.00 0.00 0.00
Total Preliminary Engineering 0.00 0.00 0.00 0.00 0.00 0.00 0.00
RW
0.00 0.00 0.00
0.00 0.00 0.00
Total Right of Way 0.00 0.00 0.00 0.00 0.00 0.00 0.00
CN
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
0.00 0.00 0.00
CE
0.00 0.00 0.00
0.00 0.00 0.00
Total Construction 0.00 0.00 0.00 0.00 0.00 0.00 0.00
TOTAL PROJECT 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Submission of this request for payment certifies that in accordance with the laws of the State of Washington and under the conditions of approval for the project identified above, actual costs claimed
have been incurred and are eligible for the purposes specified; also, that no other claims have been presented to, or payment made by, the State of Washington for those costs claimed for reimbursement.
Signee Title Date Approved by Regional Local Programs Office Date
Revised 06/16/97
Return to Regional Local Programs Office
f Washington and under the conditions of approval for the project identified above, actual costs claimed
been presented to, or payment made by, the State of Washington for those costs claimed for reimbursement.
State Funded Progress Billing
State Project Number: Progress Bill No:
Fed Tax ID No. Agreement Number: Final Progress Bill?
Agency Use: Last Supplement : Billing Period from:
Project Title: through:
1 2 3 4 5 6 7 8
Total Total Participation Amount Claimed Amount Total Claimed Amount Remaining
Eligible Eligible Rate This Period Claimed To Date Authorized Federal Funds
PE This Period To Date Col 1 x Col 3 Prior Periods Col 4 + Col 5 Per Agreement Col 7 - Col 6
Total Preliminary Engineering
RW
Total Right of Way
CN
CE
Total Construction
TOTAL PROJECT
Submission of this request for payment certifies that in accordance with the laws of the State of Washington and under the conditions of approval for the project identified above, actual costs claimed
have been incurred and are eligible for the purposes specified; also, that no other claims have been presented to, or payment made by, the State of Washington for those costs claimed for reimbursement.
Signee Title Date Approved by Regional Local Programs Office Date
Revised 06/16/97
Return to Regional TransAid Office
f Washington and under the conditions of approval for the project identified above, actual costs claimed
been presented to, or payment made by, the State of Washington for those costs claimed for reimbursement.