STATE OF EXAMPLE FORM 1FS CONSTRUCTION FUND Page 3 REIMBURSABLE EXPENSES AND EXTRA COMPENSATION (Full Service Agreements) Complete items A through D and H for all requests. Complete items E, F and G as applicable. Refer to the Fund’s on Payment of Consultant Fees” for detailed instructions. “Bulletin A PAYEE B D INVOICE DATE SUCF PROJECT NO. CONSULTANT’S PROJECT C CONTRACT NO. D- NO. AUTHORIZATION CURRENT E SUCF USE REIMBURSABLE EXPENSES: LETTER NO. REQUEST 1. Transportation, Meals and Lodging $ 1,123.00 2. Long Distance Telephone 25.00 3. Reproductions / Postage 546.50 4. Advertisement for Bids 150.00 (To Page 1) 5. TOTAL $ 1,844.50 F COMPENSATION: 1. Models, Photos, Renderings 1 $ 500.00 2. Drawings 2 1,625.00 7 100.00 3. Special Technical Engineering and Consultant Services 4 800.00 4. Testing Labs, Surveys, Borings and Photos 5. Significant Program Changes 6. Change Orders 7. Site Representative and Field Expense 8. Alternates 9. Contractor Default and Casualty (To Page 1) 10. TOTAL $ 3,025.00 G (To Page 1) SPECIAL COMPENSATION $ 0 H TOTAL (Add Lines E5, F10 and G) $ 4,869.50 FOR SUCF USE: I hereby certify that supporting documents and/or records have been with the Fund. The documents have been examined in accordance with contract terms, Fund standards, and those standards set forth by the State Comptroller. Payment in the amount indicated has been found to be a proper State charge and is therefore approved. SUCF Auditor: Date:
STATE OF EXAMPLE FORM 1FS CONSTRUCTION FUND Page 3 REIMBURSABLE EXPENSES AND EXTRA COMPENSATION (Full Service Agreements) Complete items A through D and H for all requests. Complete items E, F and G as applicable. Refer to the Fund’s “Bulletin on Payment of Consultant Fees” for detailed instructions. A PAYEE B INVOICE DATE D SUCF PROJECT NO. C CONTRACT NO. D- CONSULTANT’S PROJECT NO. E REIMBURSABLE EXPENSES: AUTHORIZATION LETTER NO. CURRENT REQUEST SUCF USE 1. Transportation, Meals and Lodging $ 1,123.00 2. Long Distance Telephone 25.00 3. Reproductions / Postage 546.50 4. Advertisement for Bids 150.00 5. TOTAL $ (To Page 1) 1,844.50 F COMPENSATION: 1. Models, Photos, Renderings $ 1 500.00 2. Drawings 2 1,625.00 3. Special Technical Engineering and Consultant Services 7 100.00 4 800.00 4. Testing Labs, Surveys, Borings and Photos 5. Significant Program Changes 6. Change Orders 7. Site Representative and Field Expense 8. Alternates 9. Contractor Default and Casualty 10. TOTAL $ (To Page 1) 3,025.00 G SPECIAL COMPENSATION $ (To Page 1) 0 H TOTAL (Add Lines E5, F10 and G) $ 4,869.50 FOR SUCF USE: I hereby certify that supporting documents and/or records have been with the Fund. The documents have been examined in accordance with contract terms, Fund standards, and those standards set forth by the State Comptroller. Payment in the amount indicated has been found to be a proper State charge and is therefore approved. SUCF Auditor: Date:
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