Orange County NC Website
INSTRUCTIONS FOR PREPARING CERTIFICATE OF COMPLETION <br /> Prepare original and two copies with original signatures. <br /> All dollar amounts which are entered on this form must be shown to two places past the decimal. Example: $25,000.00. <br /> Section 1. Name of Recipient— Enter the name shown in Block 1 of NRCD Funding Approval Form. <br /> Section 2. Grant Number— Enter the number shown in Block 2 of NRCD Funding Approval Form. <br /> Section 3. Project Number— Enter the number shown in Block 3 of NRCD Funding Approval Form. <br /> Section 4. Project Name— Enter the name shown in Block 3 of NRCD Funding Approval Form. <br /> Section 5. Final Statement of Cost <br /> Column (b) <br /> Lines a thru m —For each applicable program activity category listed, enter paid costs charged to the approved grant amount or <br /> to program income and claimed as eligible for inclusion in the total program cost. Do not include costs which <br /> are charged to other fund sources, such as other State grants, Federal grants, or local funds. <br /> Line n — Enter the sum of lines a thru m. <br /> Line o— Enter the amount of program income used to pay program costs. <br /> Line p— Subtract the amount on Line o from n and enter the difference. <br /> Column (c) <br /> Lines a thru m —For each applicable program activity category listed,enter unpaid costs chargeable to the approved grant amount <br /> or to program income and claimed as eligible for inclusion in the total program costs. Unpaid costs are firmly <br /> determined costs for which payment has not as yet been made(i.e.,accounts payable and relocation payments <br /> owed_in the future). Do not include amounts budgeted for unsettled third-party claims. <br /> Line n — Enter the sum of Lines a thru m. <br /> Line b -- Enter the amount of program income to be applied to the payment of unpaid program costs. <br /> Line p— Subtract the amount on Line o from n and enter the difference. <br /> Column (d) —Enter the sum of the amounts in Columns (b) and (c). <br /> Column (e) —For NRCD use only. <br /> Section 6. Computation of Grant Balance <br /> Column (b) <br /> Line 1 -- Enter the total amount shown on Line p,'Column (d). <br /> Line 2 — Enter the amount budgeted for unsettled third-party claims against the recipient's grant. Unsettled third-party claims are <br /> liabilities which are contingent on the outcome of disputes involving the recipient and third-parties.This amount shall <br /> not be included in Section C. <br /> Line 3 -- Enter the sum of Lines 1 and 2. <br /> Line 4— Enter the sum of the grant amounts shown on NRCD Funding Approval Form. <br /> Line 5 — Subtract the amount on Line 3 from 4 and enter the difference. <br /> Line 6— Enter the amount of grant funds received to date through a letter of credit or other grant disbursement mechanism. <br /> Line 7 — Subtract the amount on Line 6 from 3 and enter the difference. <br /> Column (c) -- For NRCD use only. <br /> Section 7. Unpaid Costs and Unsettled Third-Party Claims— <br /> List any unpaid costs and unsettled third-party claims,and describe the circumstances and amounts involved.The total amount <br /> of unpaid costs described must equal the amount shown on Line n,Column(c),and the total amount of unsettled third-party <br /> claims described must equal the amount shown on Line 2, Column (b). <br /> Section 8. Remarks — Self-explanatory. <br /> Section 9. Certification of Recipient— Self-explanatory. <br /> Section 10. NRCD Approval — For NRCD use only. <br />