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Grant Manager's Certification <br />of Disbursement Request <br />(name of Grantee's Grant Manager designated in the Agreement) <br />on behalf of , do hereby certify that: <br />(name of Grantee/Recipient) <br />1. The disbursement amount requested on Page 1 of this form is for allowable costs for the project described in the <br />Agreement. <br />2. Materials, labor, equipment, and/or services representing costs included in the amount requested have been <br />satisfactorily purchased, performed or received, and applied toward completing the project; such costs are <br />documented by invoices or other appropriate documentation which are filed in the Grantee's permanent records. <br />3. The Grantee is required to pay such costs under the terms and provisions of contracts relating directly to the project, <br />and the Grantee is not in default of any terms or provisions of the contracts. <br />4. All funds received to date have been applied toward completing the project. <br />5. All permits and approvals required for the construction which is underway have been obtained. <br />( Signature of Grant Manager) <br />(Date) <br />DEP Agreement No. LP6822, Attachment B, Page 2 of 3 <br />