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COVID-19 Disparities Initiative
Invoice Cover Page
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Contractor Name:Boro Park Jewish Community Council, IncFPHNYC Contract #:84289
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Contractor Address:1310 46 StContract Period:12/1/21-5/31/23
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Brooklyn, NY 11219Invoice #: 1
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Invoice Period:2/1/22-2/28/22
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Total Amount Requested$87,942.71
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Certification
By signing this report, I hereby certify to the best of my knowledge and belief that (I) the amounts claimed through this voucher represent amounts due to my organization by the Fund for Public Health in New York; (II) this claim is just, true, and correct; and (III) the request represents actual costs incurred during the invoice period and that these costs are appropriate and in accordance with this Agreement.
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Contractor Signature:Date:
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Title:Executive Director
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Email:agreenstein@unitedjewish.orgTelephone:718-972-6600
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FOR DOHMH USE ONLY
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Authorizing Signature:
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Name:
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Title
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Authorizing Signature:
DOHMH Amount Approved
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Name:
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Title
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FOR FPHNYC USE ONLY
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Approved AmountOriginal Advance Amount
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Advance Recoup Current Period
Advance Recoup Prior Period(s) $ -
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Advance Recoup Current Period(25% of invoice)
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FPHNY Approved Payment
 $ - Advance Balance $ -
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Authorizing Signature:
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Name:
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Title:
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