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INSTRUCTIONS FOR PREPARING CERTIFICATION OF COMPLETION Prepare original and one copy with original signatures. (A separate page 1 must be completed for each project). All dollar amounts, which are entered on this form, must be shown to two places past the decimal. Example: $25,000.00. Sections 1 - 4 will autofill from information entered on cover sheet and closeout data entry sheet Section 5. Final Statement of Cost: Column (b) Lines a through j, l and m —will autofill from information entered on activity tabs Line k, n, and p —will automatically total Line o - Enter the amount of program income to be applied to the payment of unpaid program costs. Column (c) Line a through j, l and m —For each applicable program activity category listed, enter unpaid costs chargeable to the approved grant amount or to the program income and claimed as eligible for inclusion in the total program costs. Unpaid costs are firmly determined costs for which payment has not as yet been made (i.e., accounts payable and relocation payments owed in the future). Do not include amounts budgeted for unsettled third -party claims. Line k, n, and p —will automatically total Line o —Enter the amount of program income to be applied to the payment of unpaid program costs. Column (d) –will automatically total Column (e) –For DCA use only. Section 6. Computation of Grant Balance Column (b) Line 1 –will autofill from Line p, Column (d). Line 2 –Enter the amount budgeted for unsettled third -party claims against the recipient's grant. Unsettled third -party Claims are liabilities that are contingent on the outcome of disputes involving the recipient and third - parties. This amount shall not be included in Section C. Line 3 –will autofill the sum of lines 1 and 2. Line 4 –Enter the sum of the grant amounts shown on DCA Funding Approval Form. Line 5 –will autofill line 4 minus line 3 Line 6 –Enter the amount of grant funds received to date. Line 7 –will autofill line 3 minus line 6 Column (c) For DCA use only. Section 7. Program Income (a) Enter the amount of program income on hand at the present time. (b) Enter the amount of program income that you expect to receive in the future as a result of this grant. (c) If program income is on hand or if it is anticipated, describe how you intend to spend it. Section 8. Unpaid Costs and unsettled Third -Party Claims List any unpaid costs and unsettled third -party claims, and describe the circumstances and amounts involved. The total amount of unpaid costs described must equal the amount shown on Line n, Column (c), and the total amount of unsettled third -party claims described must equal the amount shown on Line 2, Column (b) of Section 6. Section 9. Remarks – For DCA use only. Section 10. Certification of Recipient – Self explanatory. Section 11. DCA Approval- For DCA use only. Attachment number 1 G -1 Page 243