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