HomeMy WebLinkAboutExhibit 16Grant Manager's Certification
of Disbursement Request
I,
(name of Grantee's Grant Manager designated in the Agreement)
on behalf of , do hereby certify that:
(name of Grantee/Recipient)
1. The disbursement amount requested on Page 1 of this form is for allowable costs for the project described in the
Agreement.
2.. Materials, labor, equipment, and/or services representing costs included in, the amount requested have been
satisfactorily purchased, performed or received, and applied toward completing the project; such costs are
documented by invoices or other appropriate documentation which are filed in the Grantee's permanent records.
3. The Grantee is required to pay such costs under the terms and provisions of contracts relating directly to the project,
and the Grantee is not in default of any terms or provisions of the contracts.
4. All funds received to date have been applied toward completing the project.
5. All permits and approvals required for the construction which is underway have been obtained.
( Signature of Grant Manager)
(Date)
DEP Agreement No, LP6056, Attachment B, Page 2 of 3