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Invoice Number: <br /> I NVOI CE-Cost Reimbursement Contracts <br /> Snohomish County Human Services Department-3000 Rockefeller,M/S 305,Everett,WA 98201 <br /> Actual: Q Estimated: <br /> Contracting City and AddrP% Contract#: HCS-20-80-07-198 <br /> City of Everett Project Title: Motel Shelter Program <br /> 2930 Wetmore Ave Contract Manager: Debbi Trosvig <br /> Everett,WA 98201 Reporting Period: To: <br /> AUTHORIZING SIGNATURE: Date: <br /> (sign in ink) <br /> SUB Account Title Current Expenditures Contract To Date Total Contract Budget Contract Budget <br /> OBJ Expenditures Balance <br /> Misc.(mote and other Shelter <br /> crxt4) $ 100,000.00 $ 100,000.00 <br /> TOTALS $ - $ - s ioo,000.00 $ 100,000.00 <br /> REVIEWED FOR PAYMENT: <br /> AUTHORIZED FUND: <br /> ATTACH: CONTRACTOR CERTIFICATION FORM <br /> Exhibit D <br /> HCS-20-80-07-198 <br /> City of Everett <br /> Page 1 of 2 <br />