Attachment_4_-_Sample_Invoice_and_Modification_Form.pdf
PDF 227 KB Posted
- Attached to
- EXT SHF | 2026-07 Discharge Planning Services
- Solicitation number
- SFGOV-0000012066
- Issued by
- California
About this file
This is a sample invoice and modification form document for the San Francisco Sheriff's Office (SFSO) discharge planning services contract opportunity. The document provides templates that successful proposers must use for billing purposes throughout the contract term. The sample invoice form outlines the required format for submitting monthly invoices, including fields for service provider identification, invoice number, date, billing period, detailed line-item descriptions of services rendered, quantities, unit costs, and total amounts due. The invoice template specifies that proposers must itemize services by category and include supporting documentation for all claims submitted. The modification form template allows for contract amendments and changes to service delivery scope, pricing, or terms, requiring approval signatures from authorized representatives of both SFSO and the service provider before implementation.
The templates establish standardized accounting and documentation requirements that contractors must follow to receive reimbursement for discharge planning services. These forms ensure consistent financial tracking and facilitate accurate budget reconciliation for the jail reentry services program. Proposers selected for award will be required to submit all invoices and modification requests using these exact formats or formats substantially similar to those provided. The templates indicate that SFSO maintains strict controls over contract modifications and requires formal documentation of any changes to service scope or costs prior to execution.
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Text version
SFSO MONTHLY EXPENDITURE SUMMARY REPORT
Invoice No. Invoice Month: July-24 SFSO Use Only:
FSP PO#: 0000XXXX Reviewed By:
Contract ID: 10000XXXX
RFP: SHF 20XX-00 Approved By:
Program Title: Grant Period: Notes:
7/01/2024 - 06/30/2025
Insurance Expires - Gen-Auto (04-01-2025) WC - (01-01-2025)
Program Budget Categories Approved Budget Expended This Month Year-to-Date Balance
Salaries & Fringe*
Subtotal Salaries & Fringe: -$ -$ -$ -$ Operating Expenses
Subtotal Operating Expenses: -$ -$ -$ -$ Sub-Contractual Services
IT Managed Services -$ -$ -$ -$ Database Development -$ -$ -$ -$
Equipment Purchase
0 -$ -$ -$ -$ Subtotal Equipment Purchase: -$ -$ -$ -$
Administrative/Indirect Cost
Subtotal Administrative/Indirect Cost: -$ -$ -$ -$
TOTALS: -$ -$ -$ -$
INVOICE TOTAL -$
Less Advance (if any) -$
ADJUSTED PAYMENT -$
Prepared By: _______________________________________ Date: ____________________
Date: ____________________
FOR SHERIFF USE ONLY:
Date Received: ________________ ______________
Invoice Received By (Initials): ___________ Finance Approved by: ____________________________
Date Invoice Processed: ________________ Payment Amount: _____________________
Receipt ID: _______________________________ Payment Date: _________________________
Voucher ID : ______________________________ Reference #: ___________________________
Subtotal Equipment Purchase:
Rent
Program Materials/Supplies:
Office Supplies Printing Educational/Training Materials
Client Support (e.g., hygiene kits)
Vendor & Payment Date Verified:
Approved By: ______________________________________
Indirect Cost - 20%
Supplier ID / Vendor Name:
00000XXXX
Salaries & Fringe**
Client travel (public transportation)
Program Staff Travel (Local & Out of Town) Other (describe):
Postage
Program Staff Training Utilities Office Equipment Lease Office Equipment/IT/ Cell Phones
SFSO (rev 2024) SAN FRANCISCO SHERIFF'S OFFICE Program Invoice Form
Agency Name:
Program Title:
Grant Number: Date of Request:
Grant/Contract Period: Modification #:
Program Expense Item: Approved Budget Proposed Changes Revised Allocation
Budget
A) Salaries & Fringe Benefits -$ -$
B) Direct Program Operating Expenses -$ -$
C) Sub-Contract Services -$
D) Equipment Purchases -$ -$
X) Administrative/Overhead (Indirect) -$
Grand Total: -$ -$ -$
10. Justification for Budget Modification
11. How does the modification impact the design or scope of the program?
Authorized Signature of Agency - Director or Financial Officer Date:
Approval of Budget Modification:
(Sheriff's Programs Director) Date:
(Sheriff's Chief Financial Officer) Date:
San Francisco's Sheriff's Office Programs Division
FY 2024-2025 Budget Modification Request Form
Budget Modification Summary
Approval of Budget Modification Sheriff Use Only
SFSO (rev 2024)
Budget Modification
| invoce |
| Budget Mod form |
File details come from the government source that posted it. Updated .