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DEP v. IRCUD Central Gifford W WTF OGC No. 20-0891 Page 12 of 14 Personally, known or by Production of the following Identification Notary Public, State of Florida Printed/typed or stamped name: My Commission Expires: Comm ission/Serial No.: Annual Certification Form My name is (print or type name of senior management official) and do hereby testify under penalty of law that: A. I am a person with management responsibilities for (print or type name of Respondent) budget and finances. During the twelve month period immediately preceding the notary date on this Certification, there has not been any transfer or use of funds obtained by the (print or type name of Respondent) from the collection of sewer rates for any purpose not related to the management, operation, or maintenance of the Sewer System or to any capital improvement needs of the Sewer System. B. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowingly submitting false information in this certification. Sworn to and subscribed before me, by means of ❑ physical presence or ❑ online notarization, this day of , 20 by Personally, known or by Production of the following Identification Notary Public, State of Florida Printed/typed or stamped name: My Commission Expires: Commission/SerialNo.: C. If the Department requests additional information or clarification due to a partially incomplete in-kind project proposal or requests modifications due to deficiencies with Department guidelines, Respondent shall submit, by certified mail, all requested additional information, clarification, and modifications within 15 days of receipts of written notice. d. If upon review of the in-kind project proposal, the Department determines that the project cannot be accepted due to a substantial ly incomplete proposal or due to substantial deficiencies with minimum Department guidelines; Respondent shall be