Text · page 5 of 74
This document was a scan. Its text was produced by character recognition and may contain errors; check the original for exact wording.
FEDERAL AID PROJECT
SPONSOR CONSULTANT REIMBURSEMENT REQUEST
FIN 421 LL (05/12)
PAYEE ID: 16-1210859 NYS Comptroller's Contract No. Est. No. 14
(FEDERAL ID) , .
: Work Petiod (this est.) FROM 05/30/26 TO 06/26/26.
Payee Name:
Azar Design Co., Formerly Foit-Albert Assoc Current Completion Date
295 Main Street, Suite 200 MIR Date _/ / .
Buffalo (completed by SPONSOR)
New York :
14203 {
Original Contract Amount $251,392.59
Current Contract Amount $251,392.59
(includes thru approved S.A. NO. )
RRDA NO. (if applicable)
Consultant Sponsor
Prepares use only
1. Total work reported on previous estimates $144,320.16
2. Work reported on this estimate $19,533.87
3. Total work reported to date (must equal page 2) $163,854.03
4, Adjustments (Sponsor use only)
Reason _ - |
5. Retainage thru current estimate $0.00
6. Total work reported less retainage ; $163,854.03
7. Previous payments : $144,320.16
8. Payment requested or processed $19,533.87
CERTIFICATION BY CONSULTANT
I, Scott W. Dabb. , do hereby certify that lam Controller of Azar Design Co, consultant for the work referred to in the foregoing reimbursement request,
that I am the person in whose name, the foregoing account against the State of New York is rendered; that the labor,
materials, expenses or services charged for were
actually delivered, incurred or rendered, as named, heretofore, and that the prices charged are just and reasonable; that the
expenses detailed herein were actually incurred;
that the services specified were actually rendered as charged; and further, that no percentage or compensation has
been paid or promised to be paid to any manager,
trustee, officer or employee of said institution, department, board of commission by reason of the claimant having
been allowed to sell to, incur expenses for, or render
services to, said institution; and also, that to the best of my knowledge and belief, no manager, trustee,
officer or employee of said institution, department, board of commission
has or has had, any interest directly or indirectly in said article, materials, expenses or services; and that no part of the foregoing
account has been paid, and that the above
statement is true and correct,
By my signature I further certify that all partial payments due to subconsultants or subcontractors in accordance with Article
5 of the subject consultant agreement have been paid
July 6, 2026 0 4 Zo gdVia
Ue O hea
lef y
(DATE) (SIGNATURE)
CERTIFICATION BY SPONSOR
I, , do hereby certify that I am the
(Name) (Title)
in the supervision of the work described in the attached consultant's reimbursement request; that the materials, labors and
services have been furnished and the work properly
performed in accordance with the contract and that payment in the sum of $
can be made on this contract without detriment of the interests of the
sponsor, to the best of my knowledge and belief.
(DATE) (SIGNATURE)