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• • ? ?w <br />Subdivusion Name: The City of North*,.,,nsted Cuvahoga Countv Appendix E- Page 3 <br />Project I?ame: Great Northern Blvd. Reconstruction (NOMBL to Countrv Club) <br />OPWC Control No.: CAR04 Disbursement Request # <br />PROJECT MANAGER: Gary Durbin/City Engineer <br />CONTRACTOR/VENDOR PAYEE IDENTIFICATION: <br />Set forth the appropriate portion(s) of this Disbursement Request amount (all or part of the amount from H(3)) that is to be paid <br />to each of the contractors/vendors (or Subdivision) identified below, and as are supported through accompanying copies of invoices or <br />other evidence of expense. <br />1) AMOUNT TO BE PAID CONTRACTORNENDOR BY OPWC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ <br />PAYEE: <br />Address: <br />Phone: ( ) - <br />Federal Tax ID #: <br />2) AMOiJNT TO BE PAID CONTRACTOR/VENDOR BY OPWC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ <br />PAYEE: <br />Address: <br />Phone: ( ) - <br />Federal Tax ID #: <br />3) AMOUNT TO BE PAID CONTRACTORNENDOR BY OPWC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ <br />PAYEE: <br />Address: <br />Phone: ( ) - <br />Federal Tax ID #: <br />4) AMOLTNT TO BE PAID CONTRACTOR/VENDOR BY OPWC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ <br />PAYEE: <br />Address: <br />Phone: ( ) - <br />Federal Tax ID #: <br />