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<br /> Everett Forward Grant Program | Agreement | Page 10 <br />Exhibit 3: COST CERTIFICATION <br /> <br />I certify that: <br /> <br />1. I have authority and approval from the governing body on behalf of ______________________ (“Grantee”) to <br />accept proceeds from the City of Everett (the “City”) per the Agreement by and between the City and Grantee <br />from the City’s allocation of the Coronavirus Local Fiscal Recovery Fund (“CLFR”) as created by the American <br />Rescue Plan Act of 2021, Section 9901 (“ARPA”) for eligible costs included on the corresponding Payment <br />Request Form for the report period ______________. <br /> <br />2. I understand that as additional federal guidance becomes available, an amendment to the Agreement between <br />the City and Grantee may become necessary and agree to execute necessary amendments. <br /> <br />3. I understand the City will rely on this certification as a material representation in processing reimbursements or <br />payment requests. <br /> <br />4. I understand the Grantee receiving funds pursuant to this certification shall retain documentation of all uses of <br />the funds, including but not limited to invoices and/or sales receipts in a manner consistent with §200.333 <br />Retention requirements for records of 2 CFR 200 Uniform Administrative Requirements, Cost Principles, and <br />Audit Requirements for Federal Awards (Uniform Guidance). Such documentation shall be produced to the City <br />upon request and may be subject to audit by the State Auditor. <br /> <br />5. I understand any funds provided pursuant to this certification cannot be used for costs for which Grantee has <br />received any other funding whether state, federal or private in nature, for that same cost. <br /> <br />I hereby certify that I have read the above certification, and that the information and my statements provided herein <br />by me are true and correct to the best of my knowledge, and by my signature on this document, acknowledge my <br />understanding that any intentional or negligent misrepresentation or falsification of any of the information in this <br />document could subject me to punishment under federal and/or civil liability and/or in criminal penalties, including <br />but not limited to fine or imprisonment or both under Title 18, United States Code, Sec. 1001, et seq. and punishment <br />under federal law. <br /> <br />_____________________________ ______________________________ <br />Printed Name Signature <br /> <br />_____________________________ ______________________________ <br />Title Date <br /> <br /> <br /> <br />Bluewater Distilling <br />1/1/2023 - 12/31/2024 <br />09/29/2023 <br />John Lundin <br />President