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\ CHEMICAL MANUFACTURERS ASSOCIATION CHECK REQUISITION Format for 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-EPI-UPDATE (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 1-rn nn $437,395.00 $325.170.00 $112,225.00 $36.875.00 $75,350.00 AMOUNT $36,875.00 Does any of the total represent a lobbying expenditure? Yes: Amount: No: Date Required: July 71997 G/L Account No. 887-10 Requested By: Wendy Sherman j\- Sb- W-*l ^6%. Approved By Director (Up to $5,000): Has Shah Approved By Vice President (Up to $10,000): C. Price Executive Vice President (Over sio.ooo): Approved By President (Over$50,ooo): Additional Approval: Approval By Treasurer (Over$io,oo0): CMA 112822 Revised 7/96 Note: Attach appropriate supporting documentation and alter obtaining approvals, lorward to accounting. You should retain a copy for your records. kreq.frp/ A CHEMICAL MANUFACTURERS ASSOCIATION CHECK REQUISITION Format for 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-EPI-UPDATE (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 ivnnn $437,395.00 _____ $325.170.00 $112,225.00 _________ $75,350.00 AMOUNT $36,875.00 Does any of the total represent a lobbying expenditure? Yes: Amount: NoV Date Required: July 71997 G/L Account No. 887-10 Requested By: Wendy Sherman tr Approved By Director (up to $5,ooo): Has Shah Approved By Vice President (Up to $io,ooo): C. Price Approved By President (Over sso.ooo): _____ Executive Vice President (Over sio.ooo): Additional Approval: Approval By Treasurer (Oversio.ooo): CMA 112823 Revised 7/96 Note: Attach on and after obtaining approvals, forward to accounting. You should retain a copy for your records. kreq.frp/