Agenda - 06-01-1999 - 7a - Laserfiche WebLink

Browse Search

7. Program Income a) Amount of existing program income: $ o) Amount of anticipated program income: $ c) If program income exists or is anticipated, describe the proposed application(s): 8. Unpaid Costs and Unsettled Third Party Claims List any unpaid costs and unsettled third party claims against the recipient's grant. Describe the circumstances and amounts involved. 9. Remarks (For DCA Use Only) 10. Certification of Recipient It is hereby certified that all activities undertaken by the Recipient with funds provided under the grant agreement identified on page 1 hereof, have , to the best of my knowledge, been carried out in accordance with the grant agreement; that proper provisions have been made by the Recipient for the payment of all unpaid costs and unsettled third party claims identified on page 1 hereof; that the State of North Cazolina is under no obligation to make any further payment to the Recipient under the grant agreement in excess of the amount identified on Line 7 hereof; and that every statement and amount set forth in this instnunent is, to the best of my knowledge, true and correct as of this date. Date Typed Name and Title of Recipient's Signature of Recipient's Authorized Representative Authorized Representative Name: Alice M. Gordon Ch i O d f /~~ ( ~ /~ ( ~ a r, Comm range County B o Title: .~ ,(~G,-~.~- ~ ,ai- 11. DCA Approval This Certification of Completion is hereby approved. Therefore, I authorize cancellation of the unutilized contract commitment and related funds reservation and obligation of $ ,less $ previously authorized for cancellation (from Section 6, line 6, page 1). Date Typed Name and Title of DCA Authorized Official Signature of DCA Authorized Official William A. McNeil Director, Division of Community Assistance Page 2