Document ZBQo337yqXwpRwRyDJ2ynQkk0

CHEMICAL MANUFACTURERS ASSOCIATION CHECK REQUISITION Format tor contract payments Applied Epidemiology Inc. P.O. Box 2424 Amherst, MA 01004 Date: July 15 1997 Amount: $36,875.00 DESCRIPTION OF ITEM OR SERVICE Contract#: VCHC-4.0-EPWJPDATE (Initial/Number/Final) Payment covering Invoice CM97-0707 (Number or Time Period) Funds Withheld Prior to Final Original Amount Authorized Additions Via Amendments Total Amount Authorized Less Previous Payments Current Balance This Payment New Balance $346,225.00 fwwwi $437,395.00 $325.170.00 $11225.00 $36.875.00 $75,350.00 AMOUNT $36,875.00 Does any of the total represent a lobbying expenditure? Yes: Amount: Date Required: July 71997 Requested By: Wendy Sherman G/L Account No. jC Sb- ----- 887-10 Approved By Director (Up to $5,ooo): Has Shah Approved By Vice President (Up to $i0,000): C. Price Approved By President (OverS50,(XX: Executive Vice President (Qver$io.ooo): Additional Approval: Approval By Treasurer (OverSio.ooo): No:*/ Revised 7/96 Note: Attach documentation and after obtaining approvals, forward to accounting. You should retain a copy for your records. kreq.frtV CMA 170984