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COOPERATIVE AGREEMENT NO. C-1-2447 <br />_ " Nz <br />J <br />? EXHIBIT C <br />] <br /> <br />C <br />` INVOICE TEMPLATE <br />OCTA Project Title: <br />Agency: hate:.. - <br />To: Orange County Transportation Authority Invoice Number <br />550 S Main Street Invoice Date <br />P.O. Box 14184 <br />Orange, CA 92863-1584 <br />Approved FTA 5307 <br />-- <br />Attn: Adriann Cardoso 0% <br />Actual Local Match <br />rg_p a ri. a(??Styytc '?f??].(F':t= -x+ yam- <br />- <br /> $ 500,000 <br />1 $ - $ 500,000 <br />2 $ - $ 500,000 <br />3 $ - $ 500,000 <br />I hereby certify that the statements provided here are true and correct regarding the <br />Project. <br />The invoice is a true, complete and correct statement of work performed, reimbursable costs and <br />progress; <br />The backup Information included with the invoice Is true, complete and correct in all material <br />respects. <br />Signed Date <br />* This is a template. City/County can develope their own from as long as all the relavent <br />infromation is present