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003 <br /> CERTIFICATE OF COMPLETION <br /> 1. Grantee: Orange County 2. Grant Number: 04-D-2085 <br /> 3. Project Name: Infrastructure Hook-up Program 4. Project Number: C-1 <br /> 5. Final Statement of Costs <br /> � C � � • •� � <br /> To Be Completed by Recipient �• <br /> Paid Costs Unpaid Costs Total Costs Approved <br /> Program Activity Categories (Col.b+c) Total Costs <br /> (a) �) ��) (d) (e) <br /> a. Acquisition $0.00 $0.00 <br /> b. Disposition $0.00 $0.00 <br /> c. Public facilities and improvements <br /> (1) Seniorand handicapped centers $0.00 $0.00 <br /> (2) Parks,playgrounds and recreation facilities $0.00 $0.00 <br /> (3) Neighborhood facilities $0.00 $0.00 <br /> (4) Solid waste disposal facilities $0.00 $0.00 <br /> (5) Fire protection facilities and equipment $0.00 $0.00 <br /> (6) Parking facilities $0.00 $0.00 <br /> (7) Street improvements $0.00 $0.00 <br /> (8) Flood and drainage improvements $0.00 $0.00 <br /> (9) Pedestrian improvements $0.00 $0.00 <br /> (10) Otherpublicfacilities $0.00 $0.00 <br /> (11) Sewerimprovements $0.00 $0.00 <br /> (12) Waterimprovements $0.00 $0.00 <br /> d. Clearance activities $0.00 $0.00 <br /> e. Public services $0.00 $0.00 <br /> f. Relocation assistance $0.00 $0.00 <br /> g. Construction,rehab.and preservation activities <br /> (1) Construction or rehab.of com.&indust.bldgs. $0.00 $0.00 <br /> (2) Rehabilitation of privately owned buildings $0.00 $0.00 <br /> (3) Rehabilitation of publicly owned buildings $0.00 $0.00 <br /> (4) Code enforcement $0.00 $0.00 <br /> (5) Historic preservation $0.00 $0.00 <br /> h. Development financing <br /> (1) Working capital $0.00 $0.00 <br /> (2) Machinery and equipment $0.00 $0.00 <br /> i. Removal of architectural barriers $0.00 $0.00 <br /> j. Other activities $61,218.53 $61,218.53 <br /> k. Subtotal $61,218.53 $61,218.53 <br /> 1. Planning $0.00 $0.00 <br /> m. Administration $0.00 $0.00 <br /> n. Total $61,218.53 $61,218.53 <br /> o. Less: Program Income Applied to Program Costs $0.00 <br /> p. Equal: Grant Amount Applied to Program Costs $61,218.53 $61,218.53 <br /> 6. Computation of Grant Balance <br /> ToBe � C- <br /> Completed By � � • •� C <br /> Description Recipient �• <br /> (a) Amount Approved Amount <br /> (b) (c) <br /> (1) Grant Amount Applied To Program Costs(From Line p) $61,218.53 <br /> (2) Estimated Amount For Unsettled Third-Party Claims <br /> (3) Subtotal $61,218.53 <br /> (4) Grant Amount Per Grant Agreement $ 75,000.00 <br /> (5) Unutilized Grant To Be Canceled(Line 4 Minus Line 3) $ 13,781.47 <br /> (6) Grant Funds Received $ 61,218.53 <br /> (7) Balance of Grant Payable(Line 3 Minus Line 6)* <br /> * If Line 6 exceeds Line 3,enter the amount of the excess on Line 7 as a negative amount.This amount shall be repaid to DOC by <br /> check,unless DOC has previously approved use of these funds. <br />