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Exhibit B Exhibit B Sustainability Matching Grants - Boulder County, Colorado Reimbursement Request Form Contractor / Agency Information Agency Name: Contact Person: Contact Phone Number_ (Employer /Taxpayer ID Number Payee Name Transaction Date Invoice Information Invoice Number: Invoice Date: Billing Period: Description of Goods / Se Amount Total Award Amount Total reimbursed prior to this invoice Current invoke amount Award balance after imroice:, $ I certify that the goods and / or services included in this invoice comply with the spending requirements of the Boulder County, Colorado, Sustainabilty Matching Grants. Supporting documents for each line item will be furnished upon request. Sign Print Name Remit Request to: Susie Strife 303-441-4565 Rebecca Hurt 303-441-4505 rhurt@+btauldercauntv.ore Boulder County Sustainability Office P.O. Box 471 Boulder, CO II0306 Title Boulder county Use Only Date Received Received By Total Salary and Benefits $ - 1 Total Operating Expenses $ - In Cash / In Kind Match $ - Total Reimbursement Request:- $ - E Total Award Amount Total reimbursed prior to this invoice Current invoke amount Award balance after imroice:, $ I certify that the goods and / or services included in this invoice comply with the spending requirements of the Boulder County, Colorado, Sustainabilty Matching Grants. Supporting documents for each line item will be furnished upon request. Sign Print Name Remit Request to: Susie Strife 303-441-4565 Rebecca Hurt 303-441-4505 rhurt@+btauldercauntv.ore Boulder County Sustainability Office P.O. Box 471 Boulder, CO II0306 Title Boulder county Use Only Date Received Received By