R04-166 RESOLUTION NO. R04- I{~:~
A RESOLUTION OF THE CITY OF BOYNTON BEACH,
FLORIDA, AUTHORIZING AND DIRECTING THE CITY
MANAGER TO EXECUTE AN INTERLOCAL
AGREEMENT BETWEEN PALM BEACH COUNTY AND
THE CITY OF BOYNTON BEACH TO ASSIST IN THE
REMOVAL OF INVASIVE NON-NATIVE VEGETATION
IN THE LEISUREVILLE/WOOLBRIGHT PLACE PARK
SITE; AND PROVIDING AN EFFECTIVE DATE.
WHEREAS, Palm Beach County Board of Commissioners has established and
funded a grant program to financially assist municipalities and other public agencies with the
removal of invasive nonnative vegetation from publicly owned lands; and
WHEREAS, the City's Recreation and Parks Department has been awarded a $5,000
grant to remove invasive non-native plant species at Leisureville/Woolbright Place park site.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COMMISSION OF
THE CITY OF BOYNTON BEACH, FLORIDA, THAT:
Section 1. The City Commission of the City of Boynton Beach, Florida, upon
recommendation of staff, hereby authorizes and directs the City Manager to execute an
Interlocal Agreement between Palm Beach County and City of Boynton Beach, providing for
assistance in removal of invasive non-native vegetation in the Leisureville/Woolbright Place
park site, which Agreement is attached hereto as Exhibit "A".
Section 2. That this Resolution shall become effective immediately upon
passage.
S:\CA\RESOLAgreements\lnterlocals\lnterlocal Agreement PBC -Nonnative Vegetation.doc
INTERLOCAL AGREEMENT
BETWEEN
PALM BEACH COUNTY
AND
CITY OF BOYNTON BEACH, FLORIDA
DISTRICT 3
This Interlocal Agreement (hereinafter "Agreement") is made the o~ t day of ,~{O'l-- ,200~_,
between the City of Boynton Beach, a municipality located in Palm Beach County, Florida (hereinafter "Grantee") and
Palm Beach County, a political subdivision of the State of Florida, (hereinafter "County"), each one constituting a
public agency as defined in Part I of Chapter 163, Florida Statutes.
WITNESSETH
WHEREAS, Section 163.01, Florida Statutes, known as the "Florida Interlocal Cooperation Act of 1969"
authorizes local governments to make the most efficient use of their powers by enabling them to cooperate with other
localities on a basis of mutual advantage and thereby to provide sen;ices and facilities that will harmonize geographic,
economic, population and other factors influencing the needs and development of local communities; and
WHEREAS, Part I of Chapter 163, Florida Statutes, permits public agencies as defined therein to enter into
interlocal agreements with each other to jointly exercise any power, privilege, or authority which such agencies share
in common and which each might exercise separately; and
V~'HEREAS, pursuant to Chapter 125.01, Florida Statutes, the Board of County Commissioners of Palm
Beach County is empowered to establish and administer programs of conservation and to enter into agreements with
other governmental agencies within or outside the boundaries of the County for joint performance, or performance of
one unit on behalf of the other, of any of either governmental entity's authorized functions; and
SVItEREAS, certain species of prohibited invasive non-native vegetation are spreading rapidly into natural
areas in the Count),, displacing native vegetation, destroying wildlife habitat and creating undesirable vegetative
monocultures; and
WHEREAS, certain species of prohibited invasive non-native vegetation have a variety of noxious qualities,
including, but not limited to, adverse effects on human health, hazards to public safety, and undesirable aesthetics in
the County; and
WHEREAS, the 1989 Comprehensive Plan, as amended, mandates that the County shall continue efforts to
eradicate prohibited invasive non-native vegetation; and
WHEREAS, the nine prohibited invasive non-native plant species (Air Potato, Australian Pine, Brazilian
Page 1
PASSED AND ADOPTED this ~1, [ day of September, 2004.
(Corpora
CITY OF BOYNTON BEACH, FLORIDA
~~Co~er~''~
~:\CA\RESO~Agreements\lnterlocals\lnterlocal Agreement PBC -Nonnative Vegetation.doc
Pepper, Carrotwood, Earleaf Acacia, Kudzu, Old-world Climbing Fern, Melaleuca, and Queensland Umbrella Tree)
are also found in both unincorporated and incorporated areas of the County; and
WHEREAS, eradication of prohibited invasive non-native vegetation will require the combined efforts of the
municipalities and the County to stop their spread; and
WItEREAS, the Board of County Commissioners has established and funded a grant program to financially
assist municipalities and other public agencies with removal of this invasive non-native vegetation from publicly
oxvned lands and related educational activities, and
NOW, TItEREFORE, in consideration of the mutual representations, terms, and covenants hereinafter set
forth, the parties hereby agree as follows:
ARTICLE 1 - PROJECT TO BE COMPLETED BY THE GRANTEE:
The Grantee agrees, during the term of this Agreement, to assist in the removal of invasive non-native vegetation
within the County as specifically set forth in Exhibit A attached hereto and made a part hereof. The Grantee shall
coordinate work on the project with the County's Department of Environmental Resources Management, hereinafter
referred to as the Sponsoring Department, and shall submit all invoices, reports and records to the Sponsoring
Department, as specifically set forth in Exhibit B and Article 8, hereof.
ARTICLE 2 - PAYMENTS TO GRANTEE/REIB,IBURSABLE:
The County shall pay to the Grantee as reimbursement of the Grantee's expenses, an amount not to exceed $5,000.00,
provided the Grantee completes the removal project as described in Exhibit A, and meets the estimated match
requirement of $5,00~.00 as noted in Exhibit A. Activities eligible for match requirements include (actual)
contributions (e.g., equipment usage/direct operating expenses/in-kind services), funding from other non-County
grants and replacement planting with vegetation native to Florida. Costs related~o in-kind services (e.g., planning &
design) shall be limited to salaries and fringe benefits. Only those costs incurred after the effective date of the
Agreement will qualify as matching funds. County funding can be used to match grants fi-om other non-County
sources; however, the Grantee cannot submit reimbursement requests for the same expenses to more than one funding
source or under more than one County-funded program. The Grantee will bill the County upon completion of the
project, for expenses actually incurred and paid, up to the amounts set forth in Exhibit A for the project. The Grantee
shall be reimbursed on a cost reimbursement basis for all eligible project costs upon receipt and acceptance by the
Page 2
County of a properly completed Payment Request Summary Form, provided as Exhibit B. In support of the Payment
Summary form, the Grantee must also provide, from its accounting system, a listing of expenditures in detail sufficient
to evidence actual payment and that said expense was necessary in the performance of the Scope of Work described in
Exhibit A. The Grantee shall supply any further documentation such as copies of paid receipts, canceled checks,
invoices or other documents deemed necessary by the County. All supporting invoices and receipts must clearly state
that goods and/or services were invoiced to Grantee and not to an individual or "Cash." In the case of reimbursement
for a portion of a salary, the canceled check' submitted as invoice must be payable to the referenced individual and
memorandum as such on the check. Reimbursement requests received from the Grantee will be reviewed and
approved by the Department of Environmental Resources Management, 3323 Belvedere Road, Building 502, West
Palm Beach, FL 33406-1548, which wilt indicate that the expenditures have been made in conformity with this
Agreement and send the payment request to the County's Finance Department for final approval and payment. The
invoice must be submitted along with a final report, as described in Article 8 below.
ARTICLE 3 - AVAILABILITY OF FUNDS:
The obligations of the County under this Agreement are subject to the availability of funds lawfully appropriated for
its purpose by the Board of County Commissioners of Palm Beach County.
ARTICLE 4 - INSURANCE:
A. Without waiving the right to sovereign immunity as provided by Section 768.28, Florida Statutes, the Grantee
acknowledges it is self-insured under State Sovereign Immunity statutes with coverage limits of $100,000 Per Person
and $200,000 Per Occurrence; or such monetary waiver limits that may change and be set forth by the legislature,
which the County agrees to recognize as acceptable coverage for General Liability and Automobile Liability
insurance.
B. In the event the Grantee does not rely exclusively on sovereign immunity as provided by Section 768.28,
Florida Statutes, the Grantee shall agree to maintain third-party Commercial General Liability at limits not less than
$500,000 per occurrence. With respect to Commercial General Liability, Grantee shalI agree to add the County as an
"Additional Insured."
Page 3
C. The Grantee agrees to maintain or to be self-insured for Worker's Compensation & Employer's Liability
insurance in accordance with Florida Statutes, Chapter 440.
D. The Grantee shall provide a statement or Certificate of Insurance evidencing insurance, self-insurance and/or
sovereign immunity status, which County agrees to recognize as acceptable for the above required coverages. The
certificate Holder will be: Palm Beach County, Dept. of Environmental Resources Management, 3323 Belvedere Rd.,
Bldg. 502, West Palm Beach, FL 33406-1548.
ARTICLE 5 - INDEMNIFICATION:
Without waiver of limitation as provided for in Section 768.28(5), Florida Statutes, and to the extent permitted by law,
the County agrees to indemnify and hold harmless the Grantee fi.om any claims, losses, demands or cause of action of
whatsoever kind or nature that the Grantee, its agents or employees, may or could sustain as a result of or emanating
out of the terms and conditions contained in this Agreement that result fi.om the County's negligence or willful
misconduct. Without waiver of limitation as provided for in Section 768.28(5), Florida Statutes, and to the extent
permitted by law, the Grantee agrees to indemnify and hold harmless County fi.om any claims, losses, demands or
cause of action of whatsoever kind or nature that the County, its agents or employees, may or could sustain as a result
of or emanating out of the terms and conditions contained in this Agreement that result fi.om the Grantee's negligence
or willful misconduct. Nothing herein shall be construed as a waiver of sovereign immunity by either party, pursuant
to Section 768.28, Florida Statutes.
ARTICLE 6 - WARRANTY/PERSONNEL:
The Grantee warrants that all project-related services shall be performed by skilled and competent personnel to the
highest professional standards in the field. The Grantee further represents that it has, or will secure at its own expense,
all necessary personnel required to complete the project under this Agreement, and that they shall be fully qualified
and, if required, authorized, permitted and/or licensed under State and local law to complete such project. Such
personnel shall not be employees of or have any contractual relationship with the County.
ARTICLE 7 - EQUAL OPPORTUNITY PROVISION:
Page 4
The County and the Grantee agree that no person shall, on the grounds of race, color, sex, age, national origin,
disability, religion, ancestry, marital status, or sexual orientation be excluded from the benefits of, or be subjected to
any form of discrimination under any activity carried out by the performance of this Agreement.
ARTICLE 8 - GRANTEE'S PROJECT-RELATED AGREEMENTS:
The Grantee further agrees:
1. To allow the County through its Sponsoring Department to monitor Grantee to assure that the project is
completed as outlined in the Exhibit A.
2. To provide the funds for the balance of the project not funded by the County.
3. To maintain books, records, documents, and other evidence which sufficiently and properly reflects all costs
of any nature expended in the performance of this Agreement.
4. That all records shall be subject to the Public Records Law, Chapter 119, Florida Statutes.
5. That the County shall be promptly reimbursed for any funds which are misused or misspent.
6. To complete the project, and submit a final 1-2 page project report to the County by the Agreement expiration
date noted in Article 11 below. The final report shall include a Payment Request Summary Form along with
documentation, as described in Article 2 above, and a copy of a brief press release highlighting the successes
of the project and acknowledging the contribution of the grant towards the project success. Failure to submit
completed reports withh5 the specified timeframe will result in a delay in payment and/or termination of this
Agreement.
ARTICLE 9 - ACCESS AND AUDITS:
Grantee shall maintain adequate records to justify all charges, expenses and costs incurred in accordance with
generally accepted accounting principals. The County shall have access to all books, records, and documents as
required in this section for the purpose of inspection or audit during normal business hours during the term of this
Agreement and for at least three (3) years after completion of the project.
ARTICLE 10 - PUBLIC ENTITY CRIME CERTIFICATION:
As provided in F.S. 287.132-133, by entering into this Agreement or performing any work in furtherance hereof, the
Page 5
Grantee certifies that its suppliers, subcontractors and consultants who will perform hereunder, have not been placed
on the convicted vendor list maintained by the State of Florida Department of Management Services within the 36
months immediately preceding the date hereof. This notice is required by F.S. 287.133 (3) (a).
ARTICLE 11 - EFFECTIVE TERM/TERMINATION:
The term of this Agreement shall be effective on the date of execution of the Agreement by both parties and shall
continue in full force until July 1, 2005, unless otherwise terminated as provided herein. This Agreement may be
terminated by either party upon thirty (30) days written notice by the terminating party to the other party, provided that
the County will not arbitrarily or unreasonably deny funding to Grantee under the terms and conditions set forth
herein.
ARTICLE 12 - NOTICES:
The County's representative/grant manager during the term of this Agreement is identified as:
Department of Environmental Resources Management
Attn: Director
3323 Belvedere Road, Building 502
West Palm Beach, FL 33406
(561)233-2400 Fax: (561) 233-2414
The Grantee's representative/grant manager during the term of the Agreement is identified as:
Wally Majom, Recreation & Parks Director
City of Boynton Beach
100 E. Boynton Beach Blvd.
Boynton Beach, FL 33435
(561) 742-6255 Fax: (561) 742-6090
All notices required to be given under this Agreement shall be deemed sufficient to each party when delivered by
United States mail to the County and Grantee representative/grant manager identified above, respectively, and with a
copy to the Palm Beach County Attorney's Office, 301 North Olive Avenue, Sixth Floor, West Palm Beach, FL
33401.
Page 6
the application and this Agreement, this Agreement shall control. The County and the Grantee both further agree that
this Agreement sets forth the entire agreement between the parties, and that there are no promises or understandings
other than those stated herein. None of the provisions, terms and conditions contained in this Agreement may be
added to, modified, superseded or otherwise altered, except by written instrument executed by the parties hereto.
ARTICLE 18 — COUNTY'S AUTHORITY TO EXECUTE AGREEMENT
The Board of County Commissioners of Palm Beach County, Florida delegated the authority to execute this
Agreement to the County Administrator, the Director and Deputy Director of the Department of Environmental
Resources Management on February 25, 2003.
IN WITNESS WHEREOF, the Board of County Commissioners of Palm Beach County, Flonda has made and
executed this Agreement on behalf of the County and Grantee has hereunto set his /her hand the day and year above
written.
PALM BEACH COUNTY, FLORIDA
CITY OF BOYNTON BEACH, FLORIDA, BY ITS FOR ITS BOARD OF COUNTY
COMMISSION COMMISSIONERS
, r ��y
BY' ��..■f/ By: = l
: rry Taylor, Mayor ,' Date Richard E. Walesky, Directo 0 ate
/ Environmental Resources Ma . gement
U
ATTE
By:/' 14 '!, .- — _k?: ' • st APPROVED AS TO FORM AND
:P Uuti Date LEGAL SUFFICIENCY:
Assistant County Attorney
APPROVE II A T •RM AND
LEGAL FIC • :
LEGAL
MI By: __
James Cherof, city Attorney
Page 8
ARTICLE 13- ENFORCEMENT COSTS
Any costs or expenses (including reasonable attorney's fees) associated with the enforcement of the terms and/or
conditions of this Agreement shall be borne by the respective parties provided, however, that this clause pertains only
to the parties to this Agreement.
ARTICLE 14- COMPLIANCE WITH LAW
The Grantee shall comply with all applicable federal, state and local rules and regulations in providing services under
this Agreement. The Grantee acknowledges that this requirement includes compliance with all applicable federal,
state and local health and safety rules and regulations. The Grantee further agrees to include this provision in all
subcontracts issued as a result of this Agreement.
ARTICLE 15- REMEDIES
This Agreement shall be construed by and governed by the laws of the State of Florida. Any and all legal action
necessary to enforce the Agreement will be held in Palm Beach County. No remedy herein conferred upon any party
is intended to be exclusive of any other remedy, and each and every such remedy shall be cumulative and shall be in
addition to every other remedy given hereunder or now or hereafter existing at law or in equity or by statute or
otherwise. No single or partial exercise by any party of any right, power or remedy hereunder shall preclude any other
or further exercise thereof.
ARTICLE 16- SEVERABILITY
In the event that any section, paragraph, sentence, clause or provision hereof be held by a court of competent
jurisdiction to be invalid, such shall not affect the remaining portions of this Agreement and the same shall remain in
full force and effect.
ARTICLE 17 - ENTIRETY OF AGREEMENT
The Grantee agrees that the Scope of Work has been developed from the Grantee's funding application and that the
County expects performance by the Grantee in accordance with such application. In the event of a conflict between
Page 7
EXHIBIT A
City of Boynton Beach
Leisureville/Woolbright Place
Palm Beach County
2004-2005 Public Lands Grant Program
Invasive Non-Native Vegetation Removal
Pro|ect A~olicant:
Wally Majors, Recreation & Parks Director
City of Boynton Beach
100 E. Boynton Beach Blvd.
Boynton Beach, FL 33435
(561) 742-6255
f~
PALM BEACH COUNTY
PUBLIC LANDS GRANT PROGRAM
INVASIVE NON-NATIVE VEGETATION REMOVAL
ADMINISTRATIVE INFORMATION
Project Title:
co,,.c, P~,so,:
contac, ^~,,~. ~i_ty of Boy .n_t~o_n_ B_e~agh
c~. ~gYnton Beach
co.t~ct Phew: 561-742-6255
PROJECT INFORMATION
^mo..t orc.~, R~q.~t $5,000.00
Zip: ~3_3__43~5 ...........
Conta= ~-,mi~: _m_ ajorsw .~. boyn_ton-beach: fl. us
Total Project co,:.$10,000.00
Matching Funds Available? ffyes, describe the specific sources and amounts:
$5,000.00 match in funds are available in the Gity's Gapital Improvement Plan.
Estin~ted Project Start Date: 12/04
Esfin~ted Project Completion Date: 4/05
Minimum Criteria Description
Describe. in d~tail, in the space provided, how this project m~ets each of the si~ (6) minimum criteria. If more space is required, please attach a separate page and
note que~ion number.
1. Project must be submitted by a qualified applicam and must be designed to remove one or raore of the County's nine prohibited
plato species (Air potato, Ausl~alian pine, Brazilian pepper, carrotwood, earleafacacia, kudzu, old-woHd clitr~ing fern,
rmlalcuca, umbrella tree).
Austmilian pine, Brazilian pepper, earleaf Acacia, melaleuca and umbrella tree will be removed
from this project site.
2. Project must be located on public lands managed or maintained for greempace, or preservation/conservation
This project site is owned by the City of Boynton Beach and is mantained as greenspace, reserved
for a future park.
3. Project cannot be a required mitigation project with an invasive plant removal requirement.
This project is not a required miti§ation project
Public Lands Grant Program Application - Project Title: LeisurevilleNVoo!bright Place_ .
Page 2
Minimum Criteria Description - Continued
4. Project applicant must have financial means for perpetual follow-up maintenance, o~c~befo//ow-~o schedule and funding source
for perpetual maintenance
lhis site is currently maintained by the City's Division of Forestry & Grounds and will continue to be
maintained by this division. Maintenance is funded by the City's General Fund.
5. Planting/restoration plan (if applicable) must include Florida native vegetation and may not include Florida Exotic
Pest Plant Council Category I or II plant species (see www.fleppc,or~l for most current list).
This site will not be replanted at this time.
6. Project must have a minimum fifty-percent project match, except for those municipalities specified in the Project
Match Requirement section. O~m'~efunding source for match and how match will be used.
$5,000.00 match is in the City's Capital Improvement Plan. lhe match will be used with the grant to
pay a contractor to remove Austrailian pine, Brazilian pepper, earleaf acacia, melaleuca and
umbrella tree. /
7. Project cannot involve the clearing of native vegetation for maintenance purposes.
No native vegetation will be removed for maintenance in this project.
Project Location Description
Describe projec~ location, nearest cross streets, property type (natural area. open space, easement...), property u~ property owner, agency(s) with management
responsibili~. Include natural area description if applicabl~ **.4ttach a site plan showing the project elements along with a general location map and an a,rial photo
of thoproject viciniO,. Maps should be no greater than 11 " x ! 7. "**
Leisureville/Woolbright Place is located in Boynton Beach one block west of the intersection of SW
8th Street and SW 1st Court. Leisureville and Lake Boynton Estates residential properties border the
project site. The 3.5-acre site is owned by the City of Boynton Beach and is maintained as
greenspace, reserved for a future park site. Please see attached general location map and aerial
photo.
Include Project Location X, Y Coordinates in State Plane NAD 1983: X:
Public Lands Grant Program Application- Project Title: _L. eisu~r_e _vi!le__/Woo~l_bdght P!ace
Page 3
Detailed Project Description
Thir descr~otion is to answer information for scoring the applications by the judging committee and for compliance with the minimum grant criteria. Must include
project location desc~ption, targeted invasive non-native plant species, acreag~ of infextation, scope of work, will the work be preformed in-house or contracted out
contracted out, describe contract pricing), method of removal (mechanica~ herbicides, hand pulling...), project milestones, and replanting species.
Project location description
This site is located in a residential area west of 1-95 in Boynton Beach. It borders two
neighorhoods, Leisureville and Lake Boynton Estates. Some of the native vegetation includes: saw
palmetto, avacado & citrus trees, slash pine, poinciana and women's tongue. The invasive
non-native vegetation is located throughout the site and is highly visible to neighboring residents.
The Leisureville/Woolbdght Place site is currently maintained as greenspace by the City's Division
of Forestry & Grounds. Once the initial removal of the invasive non-native plant species begins, an
on-going maintenance program for this project site will be implemented, which will include
quarterly mowing and removal of exotics that may re-grow.
Targeted invasive non-native plant species
The following plant species will be targeted: Austrailian pine, Brazilian pepper, earleaf acacia,
melaleuca and umbrella tree.
Acreage of infestation
There is approximate/y 2.5 acres of infestation on this projcet site.
Scope of work
Work will be contracted out. The City will refer to the contractors on our bid list who are approved
to perform this type of work. Contractors on the bid list have been approved based on an hourly
rate. Invasive non-native plants will be removed by hand pulling and mechanical means.
We will remove approximately 50 feet around the perimeter from improved property. The city's
Division of Forestry & Grounds will implement an on-going maintenance program for the project
area that targets invasive non-native plants.
Project milestones
* An educational notice will be sent to neighboring residents describing the invasive non-native
vegetation being removed and the benefits to be derdved from this cooperative project by
November 2004.
* Contractor will be selected by November 2004.
* Project will commence in December 2004.
* Project will be completed by April 2005.
Replanting Species
We do not plan to replant at this time.
Public I_ands Grant ProD'am Application- Project Tide: Leisureville/Woolbright Place
Page 4
Project Narrative
Provide any additional information that describ~ how the proposed project will meet each of the Jud~in~ Criteria noted in the application guidelines.
The goal of this project is to target removal of Austrailian pine, Brazilian pepper, eadeaf acacia,
melaluca and umbrella tree from the Leisureville/Woolbright Place greenspace. Follow-up
monitoring and maintenance of the site by the City is available in perpetuity. The City has the
required 50% match available in our Capital Improvement Plan and is ready to commence the
project upon the exceution of the grant agreement with the Board of County Commissioners.
Certificafiorr I certify that to tI~ best of my knowledge, all of the statements contained in this application are correct and complete.
Submit 10 copies and 1 original to the following address:
Public Lands Grant Program Coordinator
Palm Beach County
Dept. of Environmental Resources Management
3323 Belvedere Road, Bldg, 502
West Palm Beach, FL 33406
Signana-e:/~....----'''~'-''~------
PrintName: Wally Majors
Recreation & Parks Director
May 7, 2004
Exhibit A
Leisureville/Woolbright Place Aerial Map
270 540 1,080
Exhibit B
Leisureville/Woolbright
Place
I Woolbright Place
sw 1st Court
Boynton Beach Blvd.
36O 720
Feet
,440
Legend
Streets
~ Park
Water Body
Exhibit C - Photos of Leisureville/Woolbright Place
Page 1 of 2
-.~
Page 2 of 2
GRANTEE:
COUNTY AGREEMENT NO.: R
DATE OF REQUEST:
AMOUNT
REQUESTED:$
EXHIBIT B
PAYMENT REQUEST FORM
FOR INTERLOCAL AGREEMENT
GRANTEE'S GRANT MANAGER:
PERFORMANCE PERIOD:
MATCHING
REQUIRED:$
GRANT EXPENDITURES SUMMARY SECTION
[Effective Date of Grant throu~,h End-of-Grant Periodl
AMOUNT OF THIS MATCHING FUNDS
CATEGORY OF EXPENDITURE REQUEST
Salaries $ $
Fringe Benefits $ $
Subcontracting:
Planning $ $
Design $ $
Removal related Costs $ $
Supplies/Other Expenses $ $
Public Information / Outreach $ $
TOTAL REQUESTED $ $
TOT~IL GRANT A GR~EMENT $
TOTAL REMAINING IN GRANT $
GRANTEE CERTIFICATION
The undersigned certifies that the mount being requested for reimbursement above were for items that were charged to
and utilized only for the above cited grant activities.
Grantee's Grant Manager's Signature
Grantee's Fiscal Agent ·
Print Name Print Name
Telephone Number
Telephone Number
Exhibit B, Page 1 of 1