BH Wine Consulting - Wick-Ed Wine Social Club 12/3/2021

Imo EVERETT WAS HINGTON City of Everett Coronavirus Local Fiscal Recovery Fund Everett Forward Grant Beneficiary Agreement—Exhibit 3 COST CERTIFICATION I certify that: 1. I have authority and approval from the governing body on behalf of Jeff Wicklund DBA Wick-Ed Wine Social Club ("Grantee")to accept proceeds from the City of Everett(the"City")per the Agreement by and between the City and Grantee from the City's allocation of the Coronavirus Local Fiscal Recovery Fund("CLFR")as created by the American Rescue Plan Act of 2021, Section 9901 ("ARPA") for eligible expenditures included on the corresponding Payment Request Form for the report period 11/01/2021-12/31/2022 2. I understand that as additional federal guidance becomes available,an amendment to the Agreement between the City and Grantee may become necessary and agree to execute necessary amendments. 3. I understand the City will rely on this certification as a material representation in processing reimbursements or payment requests. 4. I understand the Grantee receiving funds pursuant to this certification shall retain documentation of all uses of the funds, including but not limited to invoices and/or sales receipts in a manner consistent with §200.333 Retention requirements for records of 2 CFR 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards(Uniform Guidance). Such documentation shall be produced to the City upon request and may be subject to audit by the State Auditor. 5. I understand any funds provided pursuant to this certification cannot be used for expenditures for which Grantee has received any other funding whether state,federal or private in nature,for that same expense. I hereby certify that I have read the above certification,and that the information and my statements provided herein by me are true and correct to the best of my knowledge,and by my signature on this document,acknowledge my understanding that any intentional or negligent misrepresentation or falsification of any of the information in this document could subject me to punishment under federal and/or civil liability and/or in criminal penalties,including but not limited to fine or imprisonment or both under Title 18,United States Code,Sec.1001,et seq.and punishment under federal law. FF kid ni 1' Printed Name Si nature Qczes Jt; -r ///e7/ A7/ Title Date EFG Agreement Exhibit 3—Cost Certification Page loll