Agenda - 10-18-94 - VII-A - Laserfiche WebLink

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INSTRUCTIONS FOR PREPARING CERTIFICATE OF COMPLETION Prepare original and two copies with original signatures. All dollar amounts which are entered on this form must be shown to two places past the decimal. Example: $25,000.00. Section 1. Name of Recipient— Enter the name shown in Block 1 of DCA Funding Approval Form. Section 2. Grant Number— Enter the number shown in Block 2 of DCA Funding Approval Form. Section 3. Project Number— Enter the number shown in Block 3 of .DCA Funding Approval Form. Section 4. Project Name — Enter the name shown in Block 3 of DCA Funding Approval Form. Section 5. Final Statement of Cost Column (b) Lines a thru m —For each applicable program activity category listed, enter paid costs charged to the approved grant amount or to program income and claimed as eligible for inclusion in the total program cost. Do not include costs which are charged to other fund sources, such as other State grants, Federal grants, or local funds. Line n — Enter the sum of lines a thru m. Line o — Enter the amount of program income used to pay program costs. Line p — Subtract the amount on Line o from n and enter the difference. Column (c) Lines a thru m —For each applicable program activity category listed,enter unpaid costs chargeable to the approved grant amount or to program income and claimed as eligible for inclusion in the total program costs. Unpaid costs are firmly determined costs for which payment has not as yet been made(i.e., accounts payable and relocation payments owed in the future). Do not include amounts budgeted for unsettled third-party claims. Line n — Enter the sum of Lines a thru m. Line o — Enter the amount of program income to be applied to the payment of unpaid program costs. Line p — Subtract the amount on Line o from n and enter the difference. Column (d) —Enter the sum of the amounts in Columns (b) and (c). Column(e) — For CCA use only. Section 6. Computation of Grant Balance Column (b) Line 1 — Enter the total amount shown on Line p, Column (d). Line 2 — Enter the amount budgeted for unsettled third-party claims against the recipient's grant. Unsettled third-party claims are liabilities which are contingent on the outcome of disputes involving the recipient and third-parties. This amount shall not be included in Section C. Line 3 — Enter the sum of Lines 1 and 2. Line 4 — Enter the sum of the grant amounts shown on DCA Funding Approval Form. Line 5 — Subtract the amount on Line 3 from 4 and enter the difference. Line 6 — Enter the amount of grant funds received to date through a letter of credit or other grant disbursement mechanism. Line 7— Subtract the amount on Line 6 from 3 and enter the difference. Column (c) — For DCA use only. Section 7. Unpaid Costs and Unsettled Third-Party Claims — List any unpaid costs and unsettled third-party claims,and describe the circumstances and amounts involved.The total amount of unpaid costs described must equal the amount shown on Line n,Column(c),and the total amount of unsettled third-party claims described must equal the amount shown on Line 2, Column (b). Section 8. Remarks — Self-explanatory. Section 9. Certification of Recipient— Self-explanatory. 4.° 4:0016 Of this Section 10. DCA Approval — For DCA use only. isOCUipttlt were hinted al bets 0 orapproximatelvt_ ' 0.5