Laserfiche WebLink
Everett Forward Grant Program | Subrecipient Agreement | Page 19 <br />Exhibit F: Cost Certification <br />I certify that: <br />1. I have authority and approval from the governing body on behalf of <br />(“Subrecipient”) to accept proceeds from the City of Everett (the “City”) per the Agreement by and between <br />the City and Subrecipient from the City’s allocation of the Coronavirus Local Fiscal Recovery Fund as created <br />by the American Rescue Plan Act of 2021, Section 9901 (“ARPA”) for eligible costs included on the <br />corresponding Reimbursement Request Form for report period <br />through . <br /> <br />2. I understand the City will rely on this certification as a material representation in processing reimbursements <br />or payment requests. <br /> <br />3. I understand the Subrecipient receiving funds pursuant to this certification shall retain documentation of all <br />uses of the funds, including but not limited to invoices and/or sales receipts in a manner consistent with <br />§200.333 Retention requirements for records of 2 CFR 200 Uniform Administrative Requirements, Cost <br />Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Such documentation shall be <br />produced to the City upon request and may be subject to audit by the State Auditor. <br /> <br />4. I understand any funds provided pursuant to this certification cannot be used for costs for which the <br />Subrecipient has received any other funding, whether public or private in nature, for that same cost. <br />I hereby certify that I have read the above certification, and that the information and my statements provided <br />herein by me are true and correct to the best of my knowledge, and by my signature on this document, <br />acknowledge my understanding that any intentional or negligent misrepresentation or falsification of any of the <br />information in this document could subject me to punishment under federal and/or civil liability and/or in criminal <br />penalties, including but not limited to fine or imprisonment or both under Title 18, United States Code, Sec. 1001, <br />et seq. and punishment under federal law. <br /> <br /> <br /> <br /> <br />_____________________________ ______________________________ <br />Printed Name Signature <br /> <br /> <br />_____________________________ ______________________________ <br />Title Date <br /> <br />Boys & Girls Clubs of Snohomish County <br />1/1/2023 <br />12/31/2024 <br />Ken Salem <br />Director of Strategic Initiatives <br />Ken Salem <br />12/20/2023