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Authorized Representative 's Certification <br /> of Disbursement Request <br /> i, <br /> Kenneth R Ma h <br /> (name of Authorized Representative designated in the agreement) <br /> on behalf of Indian River County , 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 in the <br /> agreement. <br /> 2 . Materials, labor, equipment, and/or services representing costs included in the amount requested have been <br /> satisfactorily purchased, performed or received, and applied toward completing the project; such costs are <br /> documented by invoices or other appropriate documentation which are filed in the Project Sponsor' s permanent <br /> records. <br /> 3 . The Project Sponsor is required to pay such costs under the terms and provisions of contracts relating directly to the <br /> project, and the Project Sponsor 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. <br /> 5 . All permits and approvals required for the construction which is and ay have been obtained. <br /> ( Signature of Autho ' Re resentative) <br /> K nneth R . Macht , Chairman <br /> March 4 , 2003 <br /> (Date) <br /> Indian River Co . Approved Date <br /> Administration y� <br /> l ' tilitic � 1 OL <br /> Budget 3 � b � <br /> Legal f <br /> Risk INtanager <br /> DEP Agreement No . LP###, Attachment B , Page 2 of 3 <br />