Laserfiche WebLink
ALAMEDA COUNTY TRANSPORTATION COMMISSION <br /> TRANSPORTATION FUND FOR CLEAN AIR (TFCA) PROGRAM <br /> REQUEST FOR REIMBURSEMENT OF FUNDS <br /> FY 2011/2012 <br /> Project Sponsor: Project ID: -ALA - <br /> Project Title: <br /> Total TFCA funds programmed to project: $ <br /> Amount of funds requested for reimbursement: $ <br /> Total of previous reimbursements: $ <br /> Remaining balance after this reimbursement: $ <br /> To the best of my knowledge, the above information is true and correct and I am authorized to <br /> request this reimbursement of funds. <br /> Name and Title: <br /> Signature: Date: <br /> IMPORTANT! <br /> Please attach supporting documentation for all items for which you are seeking reimbursement. <br /> Reimbursement requests with no or incomplete supporting documentation for all items, such as copies of <br /> invoices, copies of checks as proof of payment, or detailed timesheets as proof of incurred costs for labor, <br /> will be returned to the sponsor. <br /> This section is to be completed by the Alameda CTC: <br /> To be completed by Alameda CTC's program manager To be completed by Alameda CTC accounting <br /> Project ID: Amount Paid: <br /> Date Approved: Check Number: <br /> Fund type (G /D): Date Paid: <br /> Amount: Initials: <br /> Initials: <br />