RockyHillGreenway-WF1-8-2020-request for reimbursement form DCS Use Only
Contract #:_______________________________
ASAP #:_________________________________
Reviewed by:______________________________
REQUEST FOR REIMBURSEMENT
OUTLAY REPORT and
REIMBURSEMENT FOR LWCF
PROJECTS
State Agency
E.E.A.
Division of Conservation Services
LWCF # 25-00536
Type of Request
Partial
X Final
Partial Request Number
Period Covered
From:To:
7/22/201910/27/2019
Municipality Name and Address:
MunicipalityCity of Northampton
AddressPlanning & Sustainability, 210 Main Street
CityNorthampton StateMA Zip01060
Project Name:
Rocky Hill Greenway Trail
Project Type:
Acquisition
XX Development
Renovation
Status of Funds
Classification
Billing #1Land Acquisition
$0
Relocation Costs
$0
Demolition Costs
$0
Design & Engineering
$0
Construction Costs
$469,229.04
Total Cost to Date
$469,229.04
LWCF Share at 50%
$200,000.00
Amount Previously Billed
$0
Amount Due This Billing
$200,000
Percent Complete
100%
CERTIFICATION: I certify that to the best of my knowledge and belief, the billed costs of disbursements are in accordance with the terms of the Program Agreement and that the reimbursement
represents the state share due that has not been previously requested and that an inspection has been performed and all work is in accordance with the terms and the Program Agreement
and State Standard Contract.
GRANTEE
STATE AGENCYName
Wayne Feiden
Name
Title
Director Planning & Sustainability
Phone
413.587.1265Title
Phone
Signature of Authorized Official
Date
1/08/2020
Signature of Authorized Official
Date