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["REQUEST FOR REIMBURSEMENT\nCLEAN WATER STATE REVOLVING LOAN FUND",null,null,null,"FORM RF-105\n(rvsd: 01/17)",null,"DEPARTMENT OF ENVIRONMENTAL QUALITY\nFINANCIAL SERVICES DIVISION\nP.O. BOX 4303\nBATON ROUGE, LA  70821-4303"]
[]
[]
[]
[]
["DEQ LOAN NUMBER",null,null,"DEQ AIN",null,"PAYMENT REQUEST #",null,"PAYMENT TYPE"]
[null,null,null,null,null,null,null,"PARTIAL:"]
[null,null,null,null,null,null,null,"FINAL:"]
["PERIOD COVERED BY THIS REQUEST:",null,null,null,null,"FROM:",null,"TO:"]
[]
["RECIPIENT COMMUNITY:",null,null,null,null,"PAYMENT REQUEST CONTACT"]
["NAME:",null,null,null,null,"NAME:"]
["PHONE:",null,null,null,null,"PHONE:"]
["EMAIL:",null,null,null,null,"EMAIL:"]
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["LINE ITEM\nCLASSIFICATION",null,"BUDGET\nAMOUNT",null,"PREVIOUSLY REQUESTED",null,"CURRENT AMOUNT REQUESTED",null,"TOTAL AMOUNT REQUESTED"]
[]
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["Project Inspection",null,null,null,null,null,null,null,{"$f":"E19+G19","v":0}]
["Engineering Fees",null,null,null,null,null,null,null,0]
["Contingency"]
["Legal/Admin Fees",null,null,null,null,null,null,null,0]
["Miscellaneous",null,null,null,null,null,null,null,0]
[{"$f":"IF(OR(I18>C18,I19>C19,I20>C20,I22>C22,I23>C23),\"REBUDGET NECESSARY PRIOR TO SUBMITTING THIS REQUEST\",\"\")","v":""}]
["TOTALS:",null,{"$f":"SUM(C18:D23)","v":0},null,{"$f":"SUM(E18:F23)","v":0},null,{"$f":"SUM(G18:H23)","v":0},null,{"$f":"E25+G25","v":0}]
["LESS\nPrevious Payments",null,null,null,null,null,null,null,{"$f":"E25","v":0}]
[]
["Current Amount Requested",null,null,null,null,null,null,null,{"$f":"I25-I26","v":0}]
[]
["Percentage of\nLoan Completion",null,null,null,null,null,null,null,{"$f":"IFERROR(I25/C25,\"-\")","v":"-"}]
[]
[]
["CERTIFICATION:\nAs the project engineer, designated representative, and/or loan recipient, I certify the following statements to be true and accurate, to the best of my knowledge:\n• The billed costs included in this request are in accordance with the terms of the Loan Agreement.\n• This reimbursement represents funds due which have not previously been disbursed.\n• An inspection has been performed and all work has been completed in accordance with the terms of the Loan Agreement.\n• The project, as completed as of the date of this request, has been constructed in accordance with the approved plans and specifications.\n• The undisbursed portion of the loan amount is sufficient to complete the project in accordance with the Loan Agreement and the approved plans and specifications."]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["Signature of Engineer \nor Representative",null,null,null,"Printed Name and Title",null,null,null,"Date"]
[]
[]
[]
[]
["Signature of\nLoan Recipient",null,null,null,"Printed Name and Title",null,null,null,"Date"]
[]
[]
["*** THIS SECTION TO BE COMPLETED BY LDEQ ***"]
[]
["Reviewed By (sign):",null,null,null,null,null,null,"Date:"]
[]
["Reviewed By (print):"]
[]
["Approved By (sign):",null,null,null,null,null,null,"Date:"]
[]
["Approved By (print)"]

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["REQUEST FOR REIMBURSEMENT\nCLEAN WATER STATE REVOLVING LOAN FUND",null,null,null,"FORM RF-105(a)\nConstruction",null,"DEPARTMENT OF ENVIRONMENTAL QUALITY\nFINANCIAL SERVICES DIVISION\nP.O. BOX 4303\nBATON ROUGE, LA  70821-4303"]
[]
[]
[]
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[]
["LINE ITEM\nCLASSIFICATION",null,"BUDGET\nAMOUNT",null,"PREVIOUSLY REQUESTED",null,"CURRENT AMOUNT REQUESTED",null,"TOTAL AMOUNT REQUESTED"]
[]
["Construction",null,{"$f":"'RF-105 Payment Request'!C18:D18","v":0},null,{"$f":"'RF-105 Payment Request'!E18:F18","v":0},null,{"$f":"SUMIF(A14:B23,\"Construction\",I14:J23)","v":0},null,{"$f":"E4+G4","v":0}]
["Project Inspection",null,{"$f":"'RF-105 Payment Request'!C19:D19","v":0},null,{"$f":"'RF-105 Payment Request'!E19:F19","v":0},null,{"$f":"SUMIF(A14:B23,\"Project Inspection\",I14:J23)","v":0},null,{"$f":"E5+G5","v":0}]
["Engineering Fees",null,{"$f":"'RF-105 Payment Request'!C20:D20","v":0},null,{"$f":"'RF-105 Payment Request'!E20:F20","v":0},null,{"$f":"SUMIF(A14:B23,\"Engineering Fees\",I14:J23)","v":0},null,0]
["Legal/Admin Fees",null,{"$f":"'RF-105 Payment Request'!C22:D22","v":0},null,{"$f":"'RF-105 Payment Request'!E22:F22","v":0},null,{"$f":"SUMIF(A14:B23,\"Legal/Admin Fees\",I14:J23)","v":0},null,0]
["Miscellaneous",null,{"$f":"'RF-105 Payment Request'!C23:D23","v":0},null,{"$f":"'RF-105 Payment Request'!E23:F23","v":0},null,{"$f":"SUMIF(A14:B23,\"Miscellaneous\",I14:J23)","v":0},null,0]
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[]
["Invoice Type\n(select from list)",null,"Vendor",null,null,null,"Invoice Number",null,"Amount"]

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["REQUEST FOR LOAN REBUDGET\nCLEAN WATER STATE REVOLVING LOAN FUND",null,null,null,"FORM RF-107\n(rvsd: 01/17)",null,"DEPARTMENT OF ENVIRONMENTAL QUALITY\nFINANCIAL SERVICES DIVISION\nP.O. BOX 4303\nBATON ROUGE, LA  70821-4303"]
[]
[]
[]
[]
["DEQ LOAN NUMBER",null,null,"DEQ AIN",null,"REBUDGET REQUEST #"]
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[]
[]
[]
["RECIPIENT COMMUNITY:",null,{"$f":"IF('RF-105 Payment Request'!C11:E11>0,'RF-105 Payment Request'!C11:E11,\"\")","v":""},null,null,"REBUDGET REQUEST CONTACT"]
["NAME:",null,{"$f":"IF('RF-105 Payment Request'!C12:E12>0,'RF-105 Payment Request'!C12:E12,\"\")","v":""},null,null,"NAME:",null,{"$f":"IF('RF-105 Payment Request'!H12:J12>0,'RF-105 Payment Request'!H12:J12,\"\")","v":""}]
["PHONE:",null,{"$f":"IF('RF-105 Payment Request'!C13:E13>0,'RF-105 Payment Request'!C13:E13,\"\")","v":""},null,null,"PHONE:",null,{"$f":"IF('RF-105 Payment Request'!H13:J13>0,'RF-105 Payment Request'!H13:J13,\"\")","v":""}]
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["LINE ITEM\nCLASSIFICATION",null,"CURRENT\nBUDGET AMOUNT",null,null,"CHANGE\nREQUESTED",null,"AMENDED\nBUDGET AMOUNT"]
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["Project Inspection",null,{"$f":"'RF-105 Payment Request'!C19:D19","v":0},null,null,null,null,{"$f":"C19+F19","v":0}]
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["Contingency",null,{"$f":"'RF-105 Payment Request'!C21:D21","v":0},null,null,null,null,0]
["Legal/Admin Fees",null,{"$f":"'RF-105 Payment Request'!C22:D22","v":0},null,null,null,null,0]
["Miscellaneous",null,{"$f":"'RF-105 Payment Request'!C23:D23","v":0},null,null,null,null,0]
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["TOTALS:",null,{"$f":"SUM(C18:E23)","v":0},null,null,null,null,{"$f":"SUM(H18:J23)","v":0}]
[]
["Reason for Request"]
[null,"Please amend the budget in the Loan Agreement as indicated above. This rebudget amendment is necessary for the following reason:"]
[]
[]
[]
[]
[]
[]
[]
[null,"DATE",null,null,"SIGNATURE OF AUTHORIZED COMMUNTIY REPRESENTATIVE"]
[]
["ENGINEER'S CERTIFICATION"]
[]
["\"As engineer for the Borrower in connection with the Project, we hereby certify that the disbursements made in accord with the budget, as here in above amended, will be sufficient to fully complete the Project in accordance with the Plans and Specifications approved and accepted by the Department.\""]
[]
[]
[]
[]
[null,"DATE",null,null,"SIGNATURE OF ENGINEER"]
[]
[null,null,null,null,"PRINTED NAME OF ENGINEER"]