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AGREEMENT NO. C-1-3099 <br />EXHIBIT C <br /> EXHIBIT C: INVOICE TEMPLATE <br />OCTA Project Title: <br />Agency: Date: <br />To: Orange County Transportation Authority <br />550 S Main Street <br />P.O. Box 14184 <br />Orange, CA 92863-1584 <br />Attn: Adriann Cardoso <br />Invoice Number <br />Invoice Date <br />Contract Number <br />Approved FTA 5307 <br />Actual Local Match 0% <br /> <br />Date <br />Qt <br />Descri tion ,. <br />l?rtit Price <br />ti Total FTA ?i`" <br />5307,., Local <br />.. fvlatch <br /> <br />` - Expended <br />? <br />a ° um" Itiye"??Y' <br />Invoice 'Number Date FTA 5 <br />3 <br />07 ; 5T'A 5307 r ` <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.