Text · page 26 of 81
Read the whole document on one page (all 81 pages, each with its own heading)
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. 15 (FEDERAL ID) Work Period (this est.) FROM 06/27/26 TO 07/31/26 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 $163,854.03 2. Work reported on this estimate $14,530.19 3, Total work reported to date (must equal page 2) $178,384.22 4. Adjustments (Sponsor use only) Reason 5. Retainage thru current estimate $0.00 6. Total work reported less retainage $178,384.22 7, Previous payments . $163,854.03 8. Payment requested or processed $14,530.19 CERTIFICATION BY CONSULTANT I, Scott W. Dabb. , do hereby certify that I am Controller of Azar Design Co, consultant for the work referred fo 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 [ further certify that all partial payments due to subconsultants or subcontractors in accordance with Article 5 of the subject consultant agreement have been paid. August 5, 2026 0 Bat i Cg (DATE) (SIGNATURE) CERTIFICATION BY SPONSOR L , do hereby certify that Jam 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)