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Exhibit C CERTIFICATION AS TO ACCURACY OF PAYMENT The undersigned , on behalf of and as a duly authorized representative of, , (hereinafter referred to as the "Agency") hereby certifies, to the best of Agency's knowledge, information and belief, to the Florida Department of Transportation (hereinafter referred to as the "Department") as follows: 1, That the Invoice/Reimbursement Request package for Joint Participation Agreement Number , Financial Project Number(s) , (hereinafter referred to as the "Invoice") is in compliance with the Agreement, FHWA ER Manual or other acceptable plan as developed by the Agency; and 2. That the Invoice is true and correct as determined by the Agency 's reasonable and independent investigation, measurements and verification of work performed; and 3. That the Agency hereby recommends that the Department make payment based on the attached Invoice and supporting documentation; and 4. That the Agency hereby agrees to indemnify and hold the Florida Department of Transportation, its officers and employees harmless from all liabilities, damages, costs, and attorney fees incurred and paid as a result of the negligence, recklessness, or intentional wrongful misconduct of the Agency and persons employed or utilized by the Agency in the preparation and/or audit of the Invoice, supporting documentation, and execution of the work as outlined in the Scope of Services. The Department also reserves the right to recover from the Agency any increased costs, delays or other damages to the Department due to errors and/or omissions under applicable Florida Statutes (334.044(2); 334.048.20.23(3)(a) and 337.015). 5. Monetary Amount Submitted State of Florida County of Sworn to and subscribed before me this day of , by (Print name of the person signing the Certification) Notary Public A false statement or omission made in connection with this certification is sufficient cause for suspension, revocation or denial of payment, and may subject the person and/or entity making false statement to any or all civil and criminal penalties available pursuant to applicable Federal and State Law. Commission Expires Authorized Agency Official Personally Known OR Produced Identification Type of Identification Produced By Title