Snohomish County Human Services 10/6/2022

Exhibit F BH-22-AR-04-198 City of Everett Page 2 of 2 SNOHOMISH COUNTY HUMAN SERVICES DEPARTMENT 3000 ROCKEFELLER AVENUE, M/S 305 EVERETT, WA 98201 AGENCY CERTIFICATION FORM 1. Agency Certification: I have the authority and approval from the governing body to request reimbursement from Snohomish County from the County’s allocation of the CLFR as created in Section 9901 of the American Rescue Plan Act of 2021 (“ARPA”) for eligible expenditures included on the corresponding invoice for the reporting period referenced on the Contract Face Page. 2. I understand Snohomish County will rely on this certification as a material representation in processing this reimbursement. 3. I certify the use of funds submitted for reimbursement from the CLFR under this Agreement were used only to cover those costs in accordance Section 9901 of the American Rescue Plan Act of 2021, the Interim Final Rule at 31 CFR Part 35, and Department of Treasury FAQs and guidance. 4. I understand the use of funds pursuant to this certification must adhere to official federal guidance issued. I have reviewed the Section 9901 of the American Rescue Plan Act of 2021, the Interim Final Rule at 31 CFR Part 35 and Department of Treasury (Treasury) FAQs and guidance and certify costs meet the parameters set forth therein. Any funds expended by Agency or its subcontractor(s) in any manner that does not adhere to the Section 9901 of the American Rescue Plan Act of 2021, the Interim Final Rule at 31 CFR Part 35 and Treasury FAQs and guidance shall be returned to the County for return to the Treasury. 5. I understand the Agency 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 Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), Section 200.333- Retention requirements for records. Such documentation shall be produced for the County upon request and may be subject to audit by state and/or federal representatives. 6. I understand any funds provided pursuant to this certification cannot be used as a revenue replacement for lower than expected tax or other revenue collections. 7. I understand funds received pursuant to this certification cannot be used for expenditures for which the Agency has received any other funding (whether state, federal or private in nature) for the same expense. By signing this document, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements, and cash receipts are for the purposes and objectives set forth in the terms and conditions of the federal award. I am aware that any false, fictious, or fraudulent information, or the omission of any material fact, may subject me to criminal, civil, or administrative penalties for fraud, false statements, or otherwise (United States Code Title 18, Sec. 1001 and Title 31, Section 3729-3730 and 3801-3812). AGENCY NAME: City of Everett By: Name and Title: Date: