HomeMy WebLinkAboutHousing - Certificate of Completion Whitted Forest Housing development Program _• t
RETURN THIS COPY TO THE CLERK'S OFFICE
FOR THE PERMANENT AGENDA FILE lc 5 -77
Certificate of Corn ictRUAR
1. Name of Reci ieil.—orange Count 3. Project Number: HD-1
2. Grant Number: c)l--r-8174 1 4. Project Name: Whitted Forest
5. Final Statement of Costs
To Be Completed To Be Completed
By Recipient B DCA
Paid Unpaid Total Costs Approved
Program Activity Categories Costs Costs (Col. b I c) Total Costs
a c d e)
a. Acquisition
b. Disposition
c. Public facilities and improvements
(D Senior and handicapped centers
2 Parks playgrounds and recreation facilities
3 Neighborhood facilities
4 Solid waste disposal facilities
5 Fire protection facilities and equipment
6 Parkinp,facilities
7 Public utilities other than water and sewer
8 Water and sewer improvements
9 Street improvements
10 Flood and drainage improvements
I 1 Pedestrian im rovements
12 Other public facilities
13 Sewer improvements
14 Water improvements
d. Clearance activities
e. Public services
f. Relocation assistance
g. Construction rehab. and preservation activities
1 Construction or rehab. of com. &indust. bld s.
Rehabilitation of privately owned buildings
3 Rehabilitation of publicly owned buildings
4 Code enforcement
5 Historic preservation
h Development financing
] Working capital
2 Machine ry and equipment
i. Removal of architectural barriers
j. Other activities 250,000 250,000 250 , 000
IL Subtotal 250,000 250,000 25n , nnn
1. Planning
m. Administration
n. Total 250,000 250,000 1
o. Less Program Income Applied to Program Costs
P. Equal: Grant Amount Applied to Prop—Costs 250,000 250,000 250 , 000
6. Computation of Grant Balance
To Be To Be
Completed By Completed By
Description o Recipient DCA
(a) � C �p Approved
y Y•• �'l Amount Amount
b c
1 Grant Amount AppliedTo Pro am Costs From Line ! 25Q,QQQ 250 , 000
Z Estimated Amount For Unsettled Third-Party Claims
3 Subtotal ACOCE —250,000 250 Ono
4 Grant Amount Per Grant Azreernent
5 Unulilized Grant To Be Canceled(Line 4 Minus Line INITY
6 Grant Funds Received 250,000
7 Balance of Grant Payable Line 3 Minus Line 6)* 0
* If Line 6 exceeds Line 3,enter the amount of the excess on Line 7 as a negative amount. This amount shall be
repaid to DCA by check,unless DCA has previously approved use of these funds.
7. Pro ram Income
a) Amount of existing program income: N/A
b) Amount of anticipated program income: $
c) If program income exists or is anticipated,describe the proposed application(s):
8. Unpaid Costs and Unsettled Third Party Claims
List any unpaid costs and unsettled third party claims against the recipient's grant. Describe the circumstances and amounts involved.
N/A
9. Remarks For DCA Use Only)
10. Certification of Recipient
It is hereby certified that all activities undertaken by the Recipient with funds provided under the grant agreement identified on page l
hereof,have,to the best of my knowledge,been carried out in accordance with the grant agreement;that proper provisions have been
made by the Recipient for the payment of all unpaid costs and unsettled third party claims identified on page 1 hereof;that the State of
North Carolina is under no obligation to make any further payment to the Recipient under the grant agreement in excess of the amount
identified on Line 7 hereof;and that every statement and amount set forth in this instrument is, to the best of my knowledge,true and
correct as of this date.
Date Typed Name and Title of Recipient's Signature of Recipient's
Authorized Representative Authorized Representative
Name: William Crowther
Title:Chair,Orange County Bd. of Comm.
11. DCA Approval
This Certification of Completion is hereby approved. Therefore,I authorize cancellation of the unutilized contract commitment and
related funds reservation and obligation of $ () less$ 0 previously authorized for
cancellation(from Section 6,line 6,page 1). e
Date Typed Name and Title of DCA Authorized Official Signature of DCA Authorized Official
7/9/97 William A.McNeil
Director,Division of Community Assistance �L
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