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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 <br />in the Agreement; <br />2 Materials, labor, equipment, and/or services representing costs included in the amount requested have <br />been satisfactorily purchased, performed or received, and applied toward completing the project; such <br />costs are documented by invoices or other appropriate documentation which are filed in the Grantee's <br />permanent records; <br />3. The Grantee is required to pay such costs under the terms and provisions of contracts relating directly to <br />the project; 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; and <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. LP31010, Attachment B, Page 2 of 3 <br />