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AGREEMENT NO. C-1-3099 <br />EXHIBIT C <br />F0 EXHIBIT C: INVOICE TEMPLATE <br />OCTA Project Title: <br />Agency: Date: <br />To: Orange County Transportation Authority Invoice Number <br />550 S Main Street Invoice Date <br />P.O. Box 14184 Contract Number <br />Orange, CA 92863-1584 Approved FTA 5307 <br />Attn: Adriann Cardoso Actual Local Match 0% <br />Date Qty Description Unit Price Total 5307.- Match <br /> Expended <br />I Cumulative , <br />Invoice Number Date FTA 5307- s F7TA 5307 .. <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. Local agencies may develop their own form as long as all the relevant <br />information is present.