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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: ❑x Estimated:D <br />Contracting City and Address: <br />City of Everett <br />2930 Wetmore Ave <br />Everett,WA 98201 <br />Contract #: HCS-21-80-04-198 <br />Project Title: Motel Shelter Program <br />Contract Manager: Debbi Trosvig <br />Reporting Period: <br />To: <br />AUTHORIZING SIGNATURE: <br />(sign in ink) <br />Date: <br />SUB <br />OBJ <br />Account Title <br />Current Expenditures <br />Contract To Date <br />Expenditures <br />Total Contract Budget <br />Contract Budget <br />Balance <br />M isc. (motel and other shelter <br />ems) <br />$ 82,671.00 <br />$ 82,671.00 <br />TOTALS <br />$ - <br />$ - <br />$ 82,671.00 <br />$ 82,671.00 <br />REVIEWED FOR PAYMENT: <br />AUTHORIZED FUND: <br />ATTACH: CONTRACTORCERTIFICATION FORM <br />Exhibit D <br />HCS-21-80-04-198 <br />City of Everett <br />Page 1 of 2 <br />