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ni <br />OCTA <br />EXHIBIT C: INVOICE TEMPLATE <br />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 />6 <br />y. W. ...Q . <br />$ 500,000 <br />500,000 <br />2 $ - $ 500,000 <br />3 $ - $ 500,000 <br />Invoice Number <br />Invoice Date <br />Contract Number <br />Approved FTA 5307 <br />Actual Local Match <br />AGREEMENT NO. C-2-1640 <br />EXHIBIT C <br />I hereby certify that the statements provided here are true and correct regarding the <br />Project. <br />0% <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. <br />