Docstoc

ESP-INV

Document Sample
ESP-INV Powered By Docstoc
					                                        ENVIRONMENTAL SERVICE PROVIDER (SP) INVOICE SUMMARY                                                                                The accuracy of all data in this template is the responsibility of the user.
                                                                                                                                                         Version 12.0101
From:                                                                                              From:               To:
    Environmental SP Firm Name                                                 Service Period:   MM/DD/YYYY        MM/DD/YYYY             Vendor ID #: XXXXXXXXXXXXXX
    Environmental SP Firm Address 1                                          Grantee Contract:   MM/DD/YYYY        MM/DD/YYYY            Invoice Date:      MM/DD/YYYY
    Environmental SP Firm Address 2                                              SP Contract:    MM/DD/YYYY        MM/DD/YYYY               Invoice #:    XXXXXXXXXXX
                                                                                                                                                                                                 LEGEND
To:                                                                                 Grantee:       Grantee Name                                                                                  Data input by SP
      Texas General Land Office                                               Grantee DRS #:       DRSXXXXXX            STATE Grantee Contract #: XX-XXXX-XXX-XXXX                               Data automatically generated
      Attn: Disaster Recovery Program                                             SP DRS #:        DRSXXXXXX               STATE SP Contract #: XX-XXXX-XXX-XXXX                                 Instructions
      P.O. Box 12873                                                                                                     STATE SP Work Order #:            XXXX X-X
      Austin, Texas 78711                                                                                                Total Work Order Amount $              -
                                                                                                                                                                                                 Notes:

   Work        No.                                                                                                                       Amount           STATE                                  1. To hide rows, select row(s) and then select hide.
                                                                                                                  Contracted                             Use Only
  Order         of             List of Activities within Items                                                                          Invoiced                                                 2. Number of activities (column B) must match the number
                                                                                                                    Amount
  Item #     Activities                                                                                                              This Period          (,)                                     of acitivities listed (Columns C thru G).

  Item 1         3        XX   XX    XX                                                                           $            -    $              -
                                                                                                                  $            -    $              -
                                                                                                                  $            -    $              -
                                                                                                                  $            -    $              -
                                                                                                                  $            -    $              -                       Click to Add Row
                                                                                                                  $            -    $              -
                                                                                                                                    $              -                       <- if error appears in this cell, see Note 2 above to correct error.

Summary by Activity                                                                                                                     This Period
  01a    Water Facilities                                                                                                           $             -
  01b    Sewer Facilities                                                                                                           $             -
   02    Solid Waste Disposal Facilities                                                                                            $             -
   03    Other Public Utilities (Gas)                                                                                               $             -
   04    Street Improvements                                                                                                        $             -
   05    Flood and Drainage Facilities                                                                                              $             -
  05a    Flood and Drainage – Debris Removal                                                                                        $             -
   06    Neighborhood Facilities/Community Centers                                                                                  $             -
   07    Senior Centers                                                                                                             $             -
   08    Centers for the Handicapped/Sheltered Workshops                                                                            $             -
   09    Parks, Playgrounds, and Other Recreational Facilities                                                                      $             -
   10    Fire Protection Facilities and Equipment                                                                                   $             -
   11    Parking Facilities                                                                                                         $             -
   12    Pedestrian Malls and Walkways                                                                                              $             -
   13    Specially Authorized Assistance to Privately Owned Utilities                                                               $             -
   14    Specially Authorized Public Facilities and Improvements                                                                    $             -
   15    Public Services (LIMITED TO 15% OF REQUEST)                                                                                $             -
   16    Interim Assistance                                                                                                         $             -
   18    Rehabilitation of Public Residential Structures                                                                            $             -
   20    Clearance Demolition Activities                                                                                            $             -
   21    Historic Preservation                                                                                                      $             -
   22    Removal of Architectural Barriers                                                                                          $             -
   23    Code Enforcement                                                                                                           $             -
   24    Acquisition                                                                                                                $             -
   25    Relocation Payments & Assistance                                                                                           $             -
   26    Economic Development Loan                                                                                                  $             -
   27    Economic Development Interest Subsidy                                                                                      $             -
   28    Economic Development Loan Guarantee                                                                                        $             -
   29    Special Activities by Local Development Corporations, Etc.                                                                 $             -
   31    Planning Study (NOT TO EXCEED 16%)                                                                                         $             -
                                                                                                                                    $             -

                                                                                                      Amount Previously Invoiced $                 -

                                                                                                 Amount submitted for this Invoice $               -

                                                                                            Amount remaining for this Work Order $                 -

Service Provider:
I certify that all information shown in this invoice and attachments accurately reflects the actual work performed in accordance with
the service provider contract and associated work order. I also certify that coordination with the Engineering Service Provider has occurred and that
the environmental evaluation is, to my knowledge, based on the most recent design information available at the time of review.

Signature:                                                           Date:

STATE USE ONLY

Reviewed By:                                                         Date:                          Amount reviewed for payment $

Approved By:                                                         Date:                          Amount approved for payment $




                                                                                                                                         PAGE 1 OF 3                                                                                                        Rev. 1/1/12
Do not delete this information
                                                                        Y
ID         Description                                                  N
01a        Water Facilities
01b        Sewer Facilities
02         Solid Waste Disposal Facilities
03         Other Public Utilities (Gas)
04         Street Improvements
05         Flood and Drainage Facilities
05a        Flood and Drainage – Debris Removal
06         Neighborhood Facilities/Community Centers
07         Senior Centers
08         Centers for the Handicapped/Sheltered Workshops
09         Parks, Playgrounds, and Other Recreational Facilities
10         Fire Protection Facilities and Equipment
11         Parking Facilities
12         Pedestrian Malls and Walkways
13         Specially Authorized Assistance to Privately Owned Utilities
14         Specially Authorized Public Facilities and Improvements
15         Public Services (LIMITED TO 15% OF REQUEST)
16         Interim Assistance
18         Rehabilitation of Public Residential Structures
20         Clearance Demolition Activities
21         Historic Preservation
22         Removal of Architectural Barriers
23         Code Enforcement
24         Acquisition
25         Relocation Payments & Assistance
26         Economic Development Loan
27         Economic Development Interest Subsidy
28         Economic Development Loan Guarantee
29         Special Activities by Local Development Corporations, Etc.
31         Planning Study (NOT TO EXCEED 16%)
XX




                                                                            PAGE 2 OF 3   Rev. 1/1/12
                               ENVIRONMENTAL SERVICE PROVDER
                                    INVOICE INSTRUCTIONS
These instructions must be followed by the Service Provider (SP) for timely approval and processing of invoices by
the Texas General Land Office (Land Office).
    1. All invoices shall be submitted in accordance with the invoice format provided herein. Blue text in the
        provided spreadsheet templates represents data to be entered by the SPs.
    2. Invoice amounts shall be reported by Grantee and work activity. The Environmental SP must enter the
        work activities (according to the Performance Statement) associated with each item in the work order for
        the invoice template to generate the invoice amount aggregation by work activity.
    3. Environmental SPs are required to report invoiced amounts by items listed in the work order.
    4. Invoices shall not be submitted more frequently than once per calendar month per work order. A fully
        executed Contract and Work Order must be in place before invoices can be submitted. A signed and
        dated hard copy of the invoice is required. Environmental SPs cannot invoice work order items until the
        Authority To Use Grant Funds has been executed.
    5. Invoices shall be submitted to the following address:
        Texas General Land Office
        Disaster Recovery Program
        1700 Congress Avenue, Suite 700
        Austin, Texas 78701
    6. The service period for the work being invoiced must be shown on all invoices. Service period is defined as
        the time the SP performed services on work order items being invoiced. The beginning date of the service
        period should be the earliest date the SP has begun the work on items billed on that invoice. The end
        date of the service period should be the latest date of the Authority To Use Grant Funds for all
        environmental review records included on the invoice. The service period shall not cross the Land Office’s
        fiscal year end of August 31st.
    7. A separate invoice is required for each work order. A contract summary is not required for multiple
        invoices submitted for multiple work orders.
    8. A completed Prime Contractor Progress Assessment Report (PAR), provided herein, shall be submitted
        monthly, regardless of whether the Land Office is invoiced. The PAR shall be submitted no later than the
        10th day of the month for the preceding month mailed to the following addresses:
        Mailing Address (Regular Mail Service)
        Texas General Land Office
        Attn: Maya Ingram
        P.O. Box 12873
        Austin, Texas 78711-2873




                                                     3 OF 3                                              Rev. 1/1/12

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:1
posted:2/27/2012
language:
pages:3