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Exhibit F <br />BH-22-AR-04-198 <br />City of Everett <br />Page 1 of 2 <br />Number _______ <br />INVOICE – Cost Reimbursement Contracts <br />Snohomish County Human Services Department-3000 Rockefeller, M/S 305, Everett, WA 98201 <br /> <br />Estimated: Actual: Amount of Payment: $ <br /> <br />Agency Name and Address: Contract #: BH-22-AR-04-198 <br />City of Everett Project Title: Everett Case Management Project <br /> Contract Manager: Cleo Harris <br /> Reporting Period: To: <br /> <br />AUTHORIZING SIGNATURE: _____________________________________ DATE: ______________ <br /> (sign in ink) <br /> <br />SUB Account Title Current Contract To Date Contract Budget <br />OBJ Expenditures Expenditures Budget Balance <br />10 Salaries/Wages 117,000 <br />20 Personal Benefits 48,000 <br />30 Supplies 15,000 <br />40 Prof. Services <br />42 Postage <br />42 Telephone <br />43 Mileage <br />43 Meals <br />43 Lodging <br />44 Advertising <br />45 Op. Rentals/Leasing <br />46 Insurance <br />47 Utilities <br />48 Repair/Maintenance <br />49 Printing/Copying <br />49 Dues/Subscriptions <br />49 Registration/Tuition <br /> Occupancy 20,000 <br /> Flex Funds 50,000 <br /> TOTALS 250,000 <br /> <br />CONTRACTING AGENCY MATCHING FUNDS: REVIEWED FOR PAYMENT: <br /> <br />CURRENT PERIOD: $ <br /> AUTHORIZED FUND: <br />CONTRACT TO DATE: $ <br />ATTACH: AGENCY CERTIFICATION FORM <br />