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<br />... <br /> <br />WATER CONSERVATION GRANTEE <br />INTERIM PAYMENT REQUEST FORM <br /> <br />This form is to be filled out and included with a cover memo from the requesting agencv stating the total <br />amount requested for interim payment as outlined in the workplan and contract. <br /> <br />Please list all expenditures, including personal services, in the table below. Please copy the table below <br />if additional space is needed. <br /> <br /> <br />5000 AWWA Water brochures <br />500 "SMART SETS" <br /> <br />$1,476.00 <br />$11,750.20 <br />$2,270.00 <br />$120.00 <br />$45.00 <br /> <br />500 "POP-FLUSH" Toilet Adaptors <br />500 Pre-metered postcards <br /> <br />500 Stickers <br /> <br /> <br /> <br />GRAND TOTAL: <br /> <br />$223.00 <br />$15,915.65 <br /> <br />10 extra "SMART SETS" for new construction of houses this year <br /> <br />Silt has already received an initial payment of $5,729.00 (9/3/92) <br /> <br />This request is asking for the payment to the town for the balance <br />" ...' _0. e rant mon~ <br />project. <br /> <br /> <br /> <br />5 729.00 <br /> <br />Subtract 10% Retainer: $1,591.00 <br />Interim Payment Reque t $8,595.00 <br /> <br />TOTAL INTERIM PAYMENT REQUEST <br /> <br />$8,595.00 <br /> <br />Page I of 2 <br />