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EXHIBIT 3 <br /> Invoice Voucher Template <br /> �t <br /> -" W `�� MINORITY BUSPESSES <br /> MARK <br /> BOX(ES)IF APPROPRIATE <br /> M D6 <br /> INVOICE VOUCHER ,N <br /> E Q6 <br /> Emai a scan of the signed original with supporting documents if required to <br /> PTOlrrroices@wsdotwa.gov and Cc to the assigned Community Liaison <br /> Subject 0 a <br /> VENDOR OR CLAIMANT(WARRANT TO BE PAYABLE TO) VENDOR'S CERTIFICATE.I hear by certify under penalty of <br /> perjury that the ierns and total listed herein are proper charges <br /> for materials,nrerr haidse or sevices furnished to the State of <br /> Washsngtan,and that al goods furnished and I or services <br /> rendered hate been provided without discrinii4ion co the <br /> grounds of race,cored.cdor,rnaticnal origin,sex or age. <br /> BY(SIGNATURE IN 171) <br /> FEDERAL I.D.NO.OR SOCIAL SECURITY NO.(far rep:tng personal service contract TITLE DATE <br /> pairnen s to I.R.S) <br /> INSTRUCTIONS TO VENDOR OR CLAIMANT: Show complete detail for each item below. <br /> DATE DESCPTJON CURRENT <br /> RI <br /> EXPENDITURES <br /> TDM ImplementationiAdnyrtistration and Employer Support <br /> Employer Training/Networking <br /> Total Billed This Period $0.00 <br /> AGREEMENT PROGRAM DESCRIPTION BILLWG PERIOD INVOICE NUMBER <br /> 2015-17 TOM Implementation 0 <br /> FOR WSDOT ONLY <br /> ACCOUNTING CLASSIFICATION <br /> ORG <br /> JOB NUMBER WORK SIB OBJ NET AMOUNT VOUCHERS <br /> OP NUMBER <br /> 2P6773- 0723 NZ13 631020 $0.00 Revnex�edbyGommnryUansm Date <br /> Approved by Business Services Staff Dale <br /> GCB2750 Page 11 of 13 <br />