Text · page 11 of 63
This document was a scan. Its text was produced by character recognition and may contain errors; check the original for exact wording.
FIN 421LL (05/12) REVERSE CONSULTANT'S REIMBURSEMENT REQUEST SPONSOR CONTRACT NO. ESTIMATE NO. 10 IMPORTANT: The amounts reported below for each PEN must be supported by a CONSULTANT'S REIMBURSEMENT REQUEST CONTINUTATION FORM FIN 422 A SEPARATE FORM FIN 422 must be completed for each nine digit pin. FAILURE TO REPORT ALL COSTS PROPERLY BY 9 DIGIT PIN MAY RESULT IN THE REJECTION OF THIS ESTIMATE WORKED PERFORMED MAXIMUM FUNDS PIN (MUST BE 9 DIGITS) ALLOC. THRU | REMAINING CURRENT PRIOR TO DATE SA OVER/UNDER 5765.46.121.) $4,855.31 $90,112.81 $94,968.12 $269,119.23 $174,151.11 5765.46.122 $0.00 $0.00 $0.00 $41,600.00 $41,600.00 5765,46,123 $0.00 $0.00 $0.00 $5,780.77 $5,780.77 TOTAL $4,855.31 $90,112.81 $94,968.12 $316,500.00 $221,531.88 LESS; RETAINAGE $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL NET OF ~ (RETAINAGE $4,855.31 $90,112.81 $94,968.12 $316,500.00 $221,531.88