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Am. <br />ie. -7z Washington State <br />Ira Department of Transportation <br />EXHIBIT 3 <br />Invoice Voucher Template <br />INVOICE VOUCHER <br />Email a scan of the signed original with supporting documents if required to <br />PTDlnvoicesjwsdotwa.gov and Cc to the assigned Community Liaison <br />Subject: 0 0 <br />MINORITY BUSINESSES <br />MARK 60X{ES) IF APPROPRIATE <br />M 1.7,6 <br />LJ <br />E EJ <br />VENDOR OR CLAIMANT {WARRANT TO BE PAYAELE TO <br />VENDORS CERTIFICATE I hear by ,.y urde. pena:y of <br />perjury riat the ^,e -Tis and total listed herein are proper charges <br />for materials, rrrertandse cr seyrx-s fum shed to the State ce <br />Washrgton, and t'iat all gads Lmisrled a• -.d i or rces <br />rendered have been provded without discriminacn on :he <br />grounds of race, creed. odor, raticnal orgin, sex cr a -2e. <br />EC7n7i.75g11,717,7"------------------- <br />FEDERAL ID. NO. CR SOCIAL <br />Da•omc-rils to IR.'S) <br />INSTRUCTIONS <br />DATE <br />SECURITY NO. 0- repr..rt ng percral ser.ice c*-t-ar, <br />TO VENDOR OR CLAIMANT: Show complete <br />DESCRIPTION <br />71,TLE <br />detail for each item <br />DATE <br />below. <br />CURRENT <br />EXPENDITURES <br />SUB OBJ <br />TDM Implementation/Administration and Employer Support <br />NET AMOUNT <br />VOUCHER # <br />Err oIoyer TriairingThietwor'Kind <br />0723 <br />NZ13 <br />631020 <br />50 00 <br />Total Billed This Period <br />$0.00 <br />AGREEMENT <br />PROGRAM DESCRIPTION <br />BILLING PERIOD <br />INVOICE NUMBER <br />2015-17 TDM Implementation <br />0 <br />FOR WSDOT ONLY <br />GCB2744 <br />ION <br />Reve€d byConaunfty 1.13SVI <br />Date <br />Aprxr.d. by Bus Iless Sewces Staff Date <br />Page 11 of 13 <br />19 <br />ACCOUNTING CLASSIF1C , <br />JOB NUMBER <br />WORK <br />OP <br />SUB OBJ <br />ORG <br />NUMBER <br />NET AMOUNT <br />VOUCHER # <br />2P6773- <br />0723 <br />NZ13 <br />631020 <br />50 00 <br />GCB2744 <br />ION <br />Reve€d byConaunfty 1.13SVI <br />Date <br />Aprxr.d. by Bus Iless Sewces Staff Date <br />Page 11 of 13 <br />19 <br />