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FWC Contract No. 15120 Attachment G <br /> • FLORIDA FISH AND WILDLIFE <br /> CONSERVATION COMMISSION <br /> Hunter Safety and Public Shooting Ranges <br /> CERTIFICATION OF COMPLETION STATEMENT <br /> I, <br /> (Print Name and Title) <br /> representing <br /> (Name of Local Government) <br /> do hereby certify that the Hunter Safety and Public Shooting Ranges project funded by FWC <br /> Contract No. has been completed in compliance with all terms and conditions of <br /> said Agreement; that all amounts payable for materials, labor and other charges against the <br /> project have been paid; and that no liens have been attached against the project. <br /> (Signature) (Date) <br /> WARNING "Whoever knowingly makes a false statement in writing with the intent to mislead a public servant in <br /> the performance of his or her official duty shall be guilty of a misdemeanor of the second degree,punishable as <br /> provided in s. 775.082 or s. 775.083." § 837 06,Florida Statutes. <br /> CERTIFICATE BY COMMISSION <br /> I certify: That, to the best of my knowledge and belief, the work on the above-named <br /> project has been satisfactorily completed under the terms of the Agreement. <br /> Division: <br /> By: Date: <br /> Name: <br /> Title: <br />