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<br />Grant Manager's Certification <br />of Disbursement Request <br /> <br />I, <br /> <br />(name of Grantee's Grant Manager designated in the Agreement) <br /> <br />on behal f of <br /> <br />, do hereby certi fy that: <br /> <br />(name of Grantee/Recipient) <br /> <br />1. The disbursement amount requested on Page I of this form is for allowable costs for the project described in the <br />Agreement; <br /> <br />2, Materials, labor, equipment, and/or services representing costs included in the amount requested have been <br />satisfactorily purchased, performed or received, and applied toward completing the project; such costs are <br />documented by invoices or other appropriate documentation which are filed in the Grantee's permanent records; <br /> <br />3, The Grantee is required to pay such costs under the terms and provisions of contracts relating directly to the project; <br />and the Grantee is not in default of any terms or provisions of the contracts; <br /> <br />4, All funds received to date have been applied toward completing the project; and <br /> <br />5. All permits and approvals required for the construction which is underway have been obtained, <br /> <br />( Signature of Grant Manager) <br /> <br />(Date) <br /> <br />DEP Agreement No, LP8978, Attachment B, Page 2 of 3 <br />