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DocuSign Envelope ID: OD510CD3-2A8F-436A-AA52-8F12ED721 B35 <br />Exhibit D <br />BUDGET SUMMARY REPORT FORM <br />2019-2020 Waste Reduction & Recycling Grant Program <br />City: Date: <br />Address: Phone: <br />Invoice #: <br />Report Period: <br />Preparer's Name: Contract #: <br />Total amount requested this period: <br />Total amount previously invoiced: <br />Original interlocal amount: <br />Total amount charged to date: <br />Amount remaining for completion of interlocal: <br />$ - <br />$ - <br />Task <br /># <br />Scope of Work <br />Description <br />(Task/title) <br />Budget <br />Current <br />Quarter <br />Costs <br />Amount <br />Previously <br />Invoiced <br />Remaining <br />Balance <br />1 <br />$ - <br />2 <br />$ - <br />3 <br />$ - <br />4 <br />$ - <br />5 <br />$ - <br />6 <br />$ - <br />7 <br />$ - <br />TOTALS <br />$ - <br />$ - <br />$ - <br />$ <br />For King County Use <br />Contract # 0 <br />720122 Exp.Account 54150 Task 22.000' <br />Project 1126942 Org <br />Purchase Order # Requisition # Receipt <br />Supplier # Supplier Pay Site Invoice # Payment Type <br />Total charges this period are approved <br />Project Manager: <br />for payment: $ <br />Date <br />41 <br />