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<br />Miami Dade County <br />Record Improvement Project <br />HSB456 <br /> <br />Page 2 of 3 <br /> <br />SUMMARY STATEMENT OF QUARTERLY PROJECT COSTS- Payroll Expenses <br /> <br />City: <br /> <br />Date of Claim: <br /> <br />Project Name: <br /> <br />Claim Number: <br /> <br />Name <br />Officer/Staff <br /> <br />Date of <br />Activity <br /> <br />Type of <br />Activity" <br /> <br />Total <br />Hours <br /> <br />"(Presentation, Parent Meeting, Field trip, etc.) <br /> <br />TOTAL HOURS <br /> <br />, AT$ <br /> <br />, PER HOUR = $ <br /> <br />I CERTIFY THAT PAYMENT FOR THE AMOUNT OF $ <br /> <br />IS CORRECT. <br /> <br />OFFICER/STAFF SIGNATURE: <br /> <br />OFFICER/STAFF SOCIAL SECURITY NUMBER: <br /> <br />CHIEF OF POLICE/CITY OFFICIAL SIGNATURE: <br /> <br />I VERIFY THAT THE ABOVE SERVICES WERE PROVIDED: <br /> <br />Note: Payroll registers, time sheets and or slips, documenting pavroll expenses, must be attached to process this payment. <br />