HomeMy WebLinkAbout1982-064RESOLUTION NO. 82-64
A RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS
OF INDIAN RIVER COUNTY, FLORIDA, APPROVING A PROJECT
AGREEMENT BETWEEN THE DEPARTMENT OF NATURAL RESOURCES OF
THE STATE OF FLORIDA UNDER THE FLORIDA RECREATION
DEVELOPMENT ASSISTANCE PROGRAM AND INDIAN RIVER
COUNTY.
WHEREAS, INDIAN RIVER COUNTY owns and operates a recre-
ation facility located in Indian River County, Florida called
TRACKING STATION RECREATION AREA, and
WHEREAS, the County now desires to develop access roads
and parking, dune walkways, restrooms, observation shelters, pic-
nic shelters, lifeguard stands, utilities and related site
improvements for the recreational area, and
WHEREAS, the attached agreement provides for payment to
IVDIAN RIVER COUNTY of: sixty-six and two-thirds (66-2/3%) percent
of the eligible costs for development of the park project or ONE;
HUNDRED AND EIGHTY-FIVE THOUSAND ($185,000.00) DOf,LARS whichever
is less, and
WHEREAS, the County pursuant to the agreement will
operate and maintain the project to the Department's satisfaction
for a minimum of. twenty-five (25) years and further devote
NINETY-TWO THOUSAND FIVE HUNDRED ($92,500.00) DOLLARS in cash
match or the fair market value of real property as the required
program match by local government.
NOW, THEREFORE, BE IT RESOLVED BY THE: BOARD OF COUNTY
COMMISSIONERS OF INDIAN RIVER COUNTY that th,� attached agreement
between the FLORIDA DEPARTMENT OF NATURAL RESOURCES, FLORIDA
RECREA`T'ION DEVELOPMENT ASSISTANCE PROGRAM and INDIAN RIVER COUNTY
is approved and the Chairman and the Clerk are authorized to
execute the attached agreement.
The foregoing resolution was offered by Commissioner
Bird who moved its adoption. The motion was
seconded by Commissioner Lyons and, upon being put to a
vote, the vote was as follows:
Chairman Don C. Scurlock, Jr. Aye
Vice -Chairman A. Grover Fletcher Nay
Commissioner Patrick B. Lyons Aye
Commissioner William C. Wodtke, Jr. Absent
Commissioner Dick Bird Aye
The Chairman thereupon declared the resolution duly
-1-
passed and adopted this 14th ddy of July , 1982.
BOARD OF COUNTY COMMISSIONERS
OF INDIAN RIVER COUNTY, FLORIDA
By
DON C. SCURL CK, JR. t
Chairman
- : FFMA WRiGHT; Cl.ev
APPROVEQ-' TO FORM
AND LECA UFFIC ENCY
By
G M. RANDENBURG
Qo�rnty Attorney
-2-
■1
O
40 FLORIDA DEPARTMENT OF NATURAL RESOURCES
FLORIDA RECREATION DEVELOPMENT ASSISTANCE PROGRAM
Project Agreement
FRDAP 410-41-9
(project number)
• • This agreement mado and entered into by and between the
State of Florida Department of Natural Resources hereinafter
called DEPARTMENT and Indian River County herein-
after called the PROJECT SPONSOR in furtherance of an approved
recreational program involving the parties hereto in pursuance
::f,)f which the parties hereto agree as follows:
1. This agreement be performed pursuant to Section
t ,
375. 021 (3) , Florida S,_a.'�j...^:: and Chapter BUD"J, part Imo, Clor" da
Administrative Code. In the event a dispute should arise
between the parties concr:rn.inq thc intent of the language herein
contained, the same shall be resolved by the adoption of that
meaning which furthers the intent and purpose of said actions of
the Florida Legislature and the Executive Board of thy: Depart-
n,ont of C.atural Resources. .do construction shall be contrary to
the program criteria or the agreements contained herein. It is
the intention of the parties hereto that none of the provision.,;
of: Section 163.01., Florida Statute!;, :;hall have application to
this agreement.
2. The DEPARTENT has found that outdoor recreation is
the primary purpose of the project known as 'Pr.,;•1_iny Station
Recreation Area , (Florida Recreation Development Assist-
ance Program Project Number 10-41-9 ), and enters into
this agreement with the PROJECT SPONSOR for construction of
recreational. facilities on real property, the legal description
of which is set forth in full in Exhibit "A" attached hereto
and made a part thereof.
Page 1 of 6
DNR Form 42-058
Revised 5-14-82
c®
3. The PROJECT SPONSOR will construct, or cause to be
constructed, certain recreational facilities upon such real pro-
perty described in Exhibit "A" which facilities shall be designed
and constructed in accordance with the project elements described
herein substantially in accordance with project plans as shown
and described in Exhibit "B" attached. The following shall be
considered the project elements:
Access road and parking, dune waikways, restrooms,
observation shelters, picnic shelters, lifeguard
stands, utilities related site improverdents.
4. The PROJECT SPONSOR agrees to operate and maintain the
project, to the DEPARTMENT'
_.S sa`_isfaction, for a minimum period
of twenty-five (7.5) years from the date of project completion
specified in paragraph 7 of this agreement and will pay all such
expenses as a PROJECT SPONSOR expense. The project shall be open
for public use at reasonable hours and times of the year; shall
be maintained so as to appuar attractive and inviting to the
public; shall be maintained in accordance with applicable health
standards and shall be kept reasonably safe for public use. Pro-
ject facilities and improvements shall be kept in reasonable re-
pair to prevent undue deterioration and to encourage public use.
The PROJECT SPONSOR convenants that it has full legal authority
and financial ability to operate and maintain said facilities.
5. The DEPARTMENT shall pay, on a reimbursement basis, to
the PROJECT SPONSOR 2_3percent of the eligible costs for the
development of the project or $ 185,000.00 , whichever is
less. These funds may be released in no more than three (3) in-
stallments, at the discretion of the DEPARTMENT, upon the request
of the PROJECT SPONSOR'S duly authorized agent, whose name and
title shall be submitted to the DEPARTMENT prior to commencefient
of the project. The DEPARTMENT shall retain $ 18,500.00
until completion of the project and until the required project
termination documentation has been received by the DEPARTMENT
Page 2 of 6
DNR. Form 42-058
from the PROJECT SPONSOR. Each reimbursement request shall in-
clude all documentation required by the DEPARTMENT as set forth
in paragraph 18 of this project agreement. The DEPARTMENT shall
be notified forthwith of any change in the person or authority
of the duly authorized agent.
6 The PROJECT SPONSOR agrees to expend the sum of
$ 92500 00 in cash or utilize the fair market value, or
a portion thereof, of donated or purchased, private real property,
previously approved by ,the DEPARTMENT for such purposes, as its
required program matching contribution. The PROJECT SPONSOR
further agrees to submit, at the request of the DEPARTMENT, any
.:and all required accounting records of documentation pertaining
to said contributions.
7. The PROJECT SPONSOR shall commence construction of the
project in accordance: with Exhibit "B" on or before .June 30, 198.'.
and agrees to complete said construction on or before
,lune 30, 1984 Failure by the PROJECT SPONSOR to commence or
complete development of the project by the aforementioned dates,
unless amended, shall be cause for the DEPARTMENT to Germinate
the project agreement and demand refund of any contribution made
from the Florida Recreation Development Assistance Program.
8. The PROJECT SPONSOR, through its duly authorized agent,
shall submit to the DF.PARTMENIT signed project status reports
every sixty (60) days summarizing th` work accomplished, problems
encountered, percentage of completion and other appropriate in-
formation. Photographs shall be submitted when appropriate to
reflect the work accomplished unless waived in writing by the
i
DEPARTMENT'S project administrator.
9. Should the PROJECT SPONSOR own the land described in
Exhibit "A", the PROJECT SPONSOR agrees to dedicate said land to
the public for recreational purposes in perpetuity. The PROJECT
SPONSOR further agrees that the execution of this agreement -by
the Executive Director of the Department of Natural Resources
shall constitute an acceptance of the dedication on behalf of the
general public of the State.
Page 3 of 6
DNR For; 42-058
- - - --, ,.
10. Should the PROJECT SPONSOR, during the period of time
established by paragraph 4 of this agreement, for any reason con-
vert all or any portion of the property described in Exhibit "A",
or the facilities described in Exhibit "B" to other than the
recreational purposes set forth and described in Paragraph 3,
the PROJECT SPONSOR agrees to provide, at its sole expense, with-
out further contribution from the Florida Recreation Development
Itssistance Program, a replacement project of comparable quality
and size to that which was converted to other purposes, which
replacement shall be in close proximity to the project and meet
with the approval of the DEPARTMENT. In lieu of such replacement,
-.`the PROJECT SPONSOR shall return to the DEF,,RTMENT the entire
^contribution from the Florida Recreation Development Assistance
Program.
11. Should the PROJECT SPONSOR elect to implement a user
fee system for the project, the PROJECT SPO11SOR shall impose
such fees uniformly upon all users without regard to age, sex,
race, other condition, or the political subdivision in which
the user may reside.
12. The PROJECT SPONSOR aureus to provide the DEPARTMENT
with annual attendance reports at such time the project is
opened for use by the general public. Said attendance reports;
shall be submitted to the DEPARTMENT during the month of July
of each year and shall provide attendance records for a one
year period beginning on July 1, and ending on June 30 of the
previous year., such period constituting one fiscal year.
13. The DEPARTMENT shall have the right, through its
agents, servants, and employees designated for that purpose, to
inspect the site of the project and the facilities thereon.
In addition to project inspections, which shall be conducted
at any reasonable time, the DEPARTMENT shall have access to all
Page 4 of 6
DNR Form 42-058
Revised 5-14-82
1
a
financial records relating to the project and the right to
• audit such records at any reasonable time which right shall be
continuous until such audit is completed without unreasonable
• interference with the operation of any of the facilities thereon.
14. This project agreement may be amended at the dis-
cretion of the DEPARTidENT, so long as such amendments are
pursuant to Section 375.021(3), Florida Statutes,'and Chapter
16D-5, Part II, Florida Administrative Code. Amendments, which
do not substantially alter the project's intent or scope or the
amount of program funds awarded to the PROJECT SPONSOR by the
DEPARTMENT'S Executive Board, shall be approved by the DEPART-
_�tL•:NT'S Executive Director through delegation of authority.
Otherwise, all amendments shall be approved by the DEPARTIRENT'S
Executive hoard.
15. The PROJECT SPOIi50R agrees to save and hold harmless
the DEPARTMENT, its officers, agents and employees from any and
all liabilities, claims, :.actions, damages, awards and judgements,
no matter how occasioned and no matter what the amount, arising
from the PROJECT SPONSOR'S obligations contained herein to con-
struct, operate and maintain the project.
16. The DEPARTMENT shall have the right to demand a refund,
either in whole or part, of the funds provided to the PROJECT
SPONSOR for awn -compliance with the term:. of this agreement, and
the PROJECT SPONSOR upon notification from the DEPARTMENT, agrees
to refund, and will forthwith pay, the amount of money demanded
--which payment shall be made directly to the DEPARTMENT.
17, The DEPARTMENT shall designate a project administrator,
whose name and title shall be submitted to the PROJECT SPONSOP,
responsible for the completion of the project pursuant to the pro-
vision of this project agreement. The PPOJECT SPONSOR shall be '
notified forthwith of any changes in the person or authority of the
dull authorized project administrator.
Page 5 of 6
DNR Form. 04-058
Revised 5-14-82
18. The PROJECT SPONSOR and the DEPARTMENT mutually agree
to the following special terms and conditions incorporated as
i
part of this agreement:
1. Guidelines and procedures utilized in accounting
for Florida Recreation Development -Assistance
Program funds shall be governed by the program's
Grants Accountability Policy, dated May 14, 1982,
attached hereto and Trade part of this project
agreement as Exhibit "C".
IN WITNESS WHEREOF, the parties hereto have caused these
presents to be executed by the officers and agents thereunto
lawfully authorized.
STATE OF FLORIDA Board of County Commissioners
DEPARTMENT OF NATURAL RF.SOUECES Indian River County, Florida
Bv: Bv:
Dr. Elton J. Gissendanner Don C. Scurlock, Jr!
i
Executive Director Its Agent for this�urnos,
Chairman
Attest:
Approved as to
Form and Legality:
Attorney, DNR
Page 6 of 6
DNR Form 42-058
Revised 5-14-82
s
Attest : Vic__<�.�.0
Freda Wright, C3erk
Effective Date:
Approvf.;rs :13 to form
atic;l8ufll%e11cy�
lVi. �?r�l�(1r111lUfA
tatli-4 Ali: T! L'
EXHIBIT "A"
LEGAL. DESCRIPTIO`
FOR
TRACKING STATION RECREATION AREA
Being a parcel of land lying in the East 10 acres of Government Lot 1
(the swne bF;ing known as the Government Tracking Station). Section 20,
Township 32 South, Range 40 East, Indian River County, Florida. The
boundary of said parcel being more particularly described as follo.,s:
From the Southwest corner of.said Section 20, run North 89° 42' 15" East
along the Section line, 345.80 feet, more or less to a concrete monument
marking the Southwest 15" East along the West line of said Tracking Station
212.00 feet to a concrete monument for the Point of Beginning of the parcel
to be herein described; thence continue North 0' 13' 15" East along the
same line, 788.00 feet to a concrete monument; thence run South 890 45125"
East 208.00 feet, more or less, to the Mean High Plater Line, 514.00 feet;
thence run North 89° 15' 45" West, 46.00 feet, more or less to a concrete
monument which is 25 feet, more or less West of the Ocean Bluff line;
thence continue North 890 15' 45" West on the same line, 184.28 feet to
a concrete monument; thence run South 0° 13' 15" West 295.20 feet to a
concrete monument; thence run North 89° 15' 4S" West, 116.00 feet to the
Point of Beginning. Containing 4.020 acres, more or less
EXHIBIT B - Site and Layout Plan of the Tracking Station Site
is on file in the Office of the Clerk.
FLORIDA RECREATION DEVELOPMENT ASSISTANCE PROGRAM'N
Grants Accountability Policy
I. Purpose and Applicability
This grants accountability policy establishes uniform guide-
lines and procedures to be utilized in accounting for grant funds
disbursed by the Department of Natural Resources under the Florida
Recreation Development Assici-nnce Program- it cats forth Principles
for determining eligible program costs, supportirg.documentation,
minimum reporting requirements and applies to all project sponsors
receiving funds through the program. waiver or modification of the
eligible costs, supporting documentation or reporting requirements
may be made by the Department's Executive Director, or his designee,
provided that the approval for any such changes shall be evidenced
by an appropriate provi?ion in the project agreement, or amendment
-thereto.
II. Disbursement of funds
Grant funds shall be disbursed by the Department directly to
project sponsors in accordance with good cash management principles,
on a reimbursement basis, and in no more than throe installments.
The Department shall retain ten percent (lo%) of its obligation until
final completion and approval of the project. The retainage may be
modified or waived with justification and formal approval by Depart-
ment personnel who are authorized to execute the project agreement
or amendment:,.
i:7:I. Contract Classification
IV
Program project agreements are defined as Actual Cost contracts
whereby project sponsors are reimbursed for a specified portion of
eligible project costs incurred in accomplishing the project required
by the Department.
Purchases of. Goods and/or Services
All purchases of goods and/or services for the accomplishment of
the project shall be negotiated, at a minimum, in accordance with the
provisions of Chapter 287, Part I, Florida Statutes and related Rules
of the Florida Administrative Code in effect at the time such pur-
chases are made except that single source or emergency purchases shall
be subject to authorization by the Department's project administrator
in lieu of the Department of General Services.
V. Eligible Costs, Supporting Documentation and Billing Guidelines
(a) Eligible Costs - To be eligible for reimbursement under the
program, costs must be necessary and reasonable for the effective
and efficient accomplishment of the project and be directly
May 14, 1982
Page 1 of to
.
allocable thereto pursuant to program rules and regulations.
Costs must be incurred and work performed within the project
period with the exception of contractual planning costs,
Section 16D-5.28(6), Florida Administrative Code, specifically
identified within the project agreement. Costs must be net of
all applicable credits such as purchase discounts, allowances,
sales of scrap and income from incidental services. The follow-
ing paragraphs identify eligible and ineliqible costs for
reimbursement.
1. Contractual Services.
a. Eligible - Costs of work performed by private or
independbnt contractors that is directly related to the
accomplishment of the project for a project sponsor.
b. Ineligible - Costs for work performed by private or
independent contractors pursuant to cost plus or
contingency fee contracts includirj costs related to
obtaining program grant funds.
2. Material and Supplies.
a. Eligible - All costs of materials and supplies consumed
or expended in accomplishing the project including
direct purchases as well as withdrawals from the project
sponsor's stock.
b. Ineligible - Cost of small tools (shovels, saws, hammers
drills, etc•) and clothing or uniforms worn by employee
Operating expendablfe:3 or replacement parts purchased for
project sponsor owned equipment used on•the project.
3. Donated Services, Materials, Supplies, Equipment, or Pro2ert
It. Eligible - With written authorization by the Depart-
ment's project administrator, Office Chief or Division
Director, and Executive Director, as evidenced by the
project agreement, the fair market value of donated or
j purchased real property may be used in the program,
pursuant to Section 16D-5.24, Florida Administrative
jCode, as all or part of the project sponsor's obligation
i
The project agreement shall clearly specify the method
for which values will be assigned to the real property.
b. Ineligible - Values assigned to any donated property,
I
materials or services used in accomplishing the project
except for real property as noted above.
A _ rn-Kind Services
a.
Ineligible - Expenses incurred by project sponsors for
personnel employed or equipment owned and maintained by
project sponsors.
5. Employee Benefits, Travel and Indirect Costs.
a. Ineligible - Expenses incurred by project sponsors for
employee benefits (FICA, health insurance, worker's
May 14, 1982
n-,..., 7 „c �.,
compensation, etc.), travel and per diem associated
with the project and indirect costs for general
operating expenses (telephones, postage, utilities,
etc.) and general administrative expenses (Personnel,
Purchasing, etc.)
b. Supporting Documentation
1. Contractual Services - Services provided for pro-
ject sponsors by private or independent contractors
shall be evidenced by formal agreements or contracts
executed by all appropriate parties specifying the
exact terms and conditions. Competitive bid specifi-
cations and actual bids received shall be maintained
by the project sponsor. The selection and awarding
of contractual services by the project sponsor shall
be subject to the Department's approval pursuant to
Section 16D-5.28(5), Vlorida Administrative Code.
Appropriate records (.i.e. contracts or invoices,
cancelled checks, etc.) shall be maintained by project
sponsors to support work and/or services performed
through conSr.-actual services.
2. Materials and Supolies
a. Direct Purchases - Vendor invoices shall be
maintained that include a description of the
items and quantity purchased, unit cost and
total cost, less applicable discounts. Invoices
shall also contain the delivery date and signa-
ture of a project sponsor employee assigned to
work on the project along with a description of
the general use for such materials or supplies.
Purchase orders, requisitions, cancelled checks
and competitive bid documentation as applicable,
shall be maintained as evidence of payment for
such purchases.
b. Project Sponsor Stock - Materials or supplies
taken from a project sponsor's stock or inven-
tory shall be supported by material requisitions
or other job order/project cost records signed
by the storekeeper and the project sponsor
employee assigned to work on the project. 'These
source documents shall describe items in detail
and identify the general use of such materials
in the project. Appropriate records (i.e. vendor
invoices, cancelled checks, etc.) shall -be main-
tained to support unit costs of the materials
based ?upon the project sponsor's normal method
of inventory valuation. No warehouse or over-
head charges added by the project sponsor shall
be allowed.
May 14, 1982
3. Real Property - Appraisals or other documentation
as required by the Department shall be maintained
and submitted for review to support values
established for purchased or donated real property.
C. Billing. The project sponsor shall submit the program
reimbursement request form, DNR Form. 42-057, to the Depa.
ment in accordance with the program's funding formula
de -
1 cn=c='l e.i-I,sCr1heA in Sect -ion iVu ,) L`!U1
Florida Administrative
Code. This payment request form sha11 be accompanied by
the documentation or schedules specified below for those
costs that are to be made directly to the project sponsor
upon approval of the Department's project administrator
and Office Chief or Division Director. A certification
of completion, DNR Form 42-057, by a registered architect
or engineer and the project sponsor's project administra-
tor. shall be required prior to the final disbursement of
funds, Section 16D-5.28(5), Florida Administrative Code.
In addition, a certification shall be required prior to
the final disbursement of funds by the Department from
the project sponsor's purchasing official that all such
purchases for the project were made, at a minimum, in
accordance with the provisions of Chapter 287, Part I,
Florida Statutes and applicable Rules of the Florida
Administrative Code in effect at the time the purchases
were made.
1. Contractual Services - `file Contractual Purchases
Schedule, DNR Form 42-062, shall accompany payment re
quests for reimbursement of contractual purchases.
The contractor's name, check or voucher number, cost
and general discr.iption of work performed shall be
reported to the Depar,tmcnt..
2. Materials and Surxplies.
a. Direct Purchases; - The Direct Material Purchases
Schedule, DNR Form 15-034(16), shall accompany
payment requests for reimbursement of direct
material purchases. The vendor's name, check and
voucher number, cost, and general description of
items purchased shall be reported to the Departrent
b. Project Sponsor Stork - The Grantee Stock Materia
Cost Schedule, DNR Form 15-035(16), shall accompa
payment requests for reimbursement of materials
utilized from the project sponsor's stock or in-
ventories. The material requisition data and num
ber, general description or materials used and
applicable cost shall be reported to the Department
May 14, 1982
Page 4 of 10
ill
4111
111►
3. Real Property - Values established for purchased
or real property, pursuant to Section 16-5.24,
Florida Administrative Code, shall be reported on
the payment request form only upon prior written
consent of the Department. The project sponsor
shall submit such documentation as required by the
Department to supoort the values established for
such property.
.-11LG111GLC 3111J.Aly CiVl:t, ui05•
a. The project sponsor may request advance written approval of the
Department's project administrator to submit other available
accounting record;; in lieu of the specified Department forms,
provided such alternate records contain the same detailed
information as required above in Section V.
b. The project sponsor may request advance written approval of the
Department's projoct administrator to engage independent
Certified Public Accountants to provide a i -,view and compila-
tion of project costs presented in the same general cost
categories as contained on the reimbursement request form,
DNR 42-057. Such statements shall be accepted in lieu of the
other specified Department forms required above for Section V,
only if payment requests are withheld by the project sponsor
until completion of the project and submitted with the CPA's
report. The additional cost incurred by the project sponsor
for this alternate billing method .shall not ba eligible for.
reimbursement.
VIT. Services Provided by Affiliated Aclencies.
If. services are obtained or materials purchased from subunits
or divisions of the project sponsor, such costs shall be supported
and billed in the same manner as required for the project sponsor
and reimbursement shall be requested by and made to the project
sponsor by the Department.
VIII. Record Retention and Audits.
(1) Project sponsors shall retain all records in support of the
project costs included in the payment requests for three fiscal
years (project sponsor) after the fiscal year in which final
payment was made by the Department to the project sponsor.
(2) All records of the project sponsor in support of the project
cost included in payment requests shall be subject to review
by the Department, the Auditor General, Comptroller, federal
auditors or others who may be authorized to audit the records
of the Department which involves the project sponsor. -
May 14, 1982
Page 5 of 10
IX. Forms.
Described below and attached are grant forms available to the
project sponsor from the Department. Copies may be obtained from
the Department. There is no cost involved in procurring any of
these forms:
DNR 42-057 ................ Florida Recreation Development
5-81 Assistance Program Reimburse-
ment Request Form
Revised 6-16-81
DNR 42-065 ................ Direct Material Purchases Schedule
5-82
DNR 42-064 .. Project Sponsor SCock Material
5-82 Cost Schedule '
DNR 42-062 ................ Contractual Purchases Schedule
5-82
Attachments
May 14, 1982
Page 6 of 10
V,
ANC- PRCW-_M
_U_sement ?ec zest
1. Project `lar..e :
2. _rojec_ S_onsor:
?al io:
5. Rec'uest ?e__cd Covered:
E.
Cost --- ohlica__cns Total Cblications
Catecories Since '_.ast Re^.iest to mate
a. ccnt:act::al Seriicee,
nearing and/or : esiTjl
2) Const='sction
b. ?arc: ase -1 '.!aterial
c. Toza'_s
i
d. ?.rtc,Lnt of State _ ..^.ds Pequestec
(1/3 or 2/3 0: _tens 6C;
,:IR - ^:TAY
i . ._st3r"'r crm'at ?.e^_1as t ictal stat'_' s'r.ax°_ :Coal Share
5 i
b. C'.:.-aulativp total:,
to date 5 $
a. Total ands A=nroved -_- = a,_2 Grant
IL b. Total state :''_nds .aid Czl%..:r. ib (2) ' I
C. Halarce of State Gant 5
9. ccr__licat_:on:
Z certify/ _*-at _.._s request is _orrec_ and .. and is --ased Lon
act_,al ..Cl-?at_cns of __cord by the .ro,•'C_ _ccnscr; =nat ..._3 est and
acC=..enzaL_Jn 15 reccr:!ec in 7,-e ?ro4ect __cnzcr' :; _ubl__ re-or!s.
t :ac =ay.me.^.t =_ora stat`_' (Las not Veen recei red; _:
at _: d �O_.. =^C 3...rY:_:s
are in accordance '"ith the .'1er_da Department a-
or-.4ect acree^ent includina an,; ame.^.d=eats t :er`3to; and that : rog_ess O: the
,,mzk and ser -.rices _,nd _ _ne ?ro; 'Ct ac nement are 5at_s-ac-Orf and ar9 :On 3_5-
tent with _ne ar..cunt _equest2d.
D=r--t--
:_4vj z'_cr. of ' ecr_..t_cn and tar:<s
Or ut'Or_=ec tie?resant?_t:._
ate
Dat_
.ate
Mav 14, 1982
Page 7 of
I.. sal:-ec_lanatcry.
2. project S_cnser - ?lac= the ••'=.e off the ellgible govern^ental agency
receiving !--ancial assistance •
3. `ru r - Each req :est s cu13 �e ^ :�bered staj=.;, �,�'_t.. _` e
caest se the _y nal".
,=.her one (1) 1! this is _ last billing, 3:ec-
�. ?av to - ?lace the name of the ._o ect Sconsor exact'_y as wishas
the State •-•as_ant to ':e :jade _aya'_
e$t ?er.cd Covered - . ote t: e Oates of t v _er4cc -=cn *MP
'• . eC' rend-:CT_=e: ses in-Var--ed agar -st e
request, to "_ e cur re _Lest. - -
current recuest gust t:zis pe__cd.
6.
Zte.as in t,.Iis section are to be dis= La;ped in tpo (2) main categories
as s'rcwn in column headings:
a. self-ax?lanato;!. I
b. Self-e:c2lanatcry._
c. 'totals - '.rhen _..taling under "'total Cblicatlor.s to Ddce " col'-',
i.clv.de aMount in ct:.r_ent request.
will depend cen the ty,e o:
d. This
teased (2/3) , cc=inaticn (11/3). :he stet_
rea,_*Sted must not emcn-••a the. -;e ratios.
* ~" the total rj_.4_c'= '_ccal stare '_s to
cash to Project construction, thesecra_-cs Must be ad`.er"-=
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