Text · page 3 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 421 LL (05/12) REVERSE CONSULTANT'S REIMBURSEMENT REQUEST SPONSOR CONTRACT NO. ESTIMATE NO. 23 IMPORTANT: The amounts reported below for each PIN must be supported bya 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 5763.87.121 $0.00 $164,044.54 $164,044.54 $160,698.92 ($3,345.62) 5763,87-221 $0.00 $37,979.88 $37,979.88 $27,308.76 ($10,671.12) 5763.87:321 onan ee > $858.00 $76,279.87 $77,137.87 $78,067.62 $929.75 TOTAL $858.00 $278,304.29 $279,162.29 $266,075.30 ($13,086.99) LESS: RETAINAGE $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL NET OF RETAINAGE $858.00 $278,304.29 $279,162.29 $266,075.30 ($13,086.99)