Common use of Compliance Certification Clause in Contracts

Compliance Certification. Under penalty of law , I hereby certify to the best of my know ledge and belief, the above inf ormation is correct; expenditures are properly documented, and are valid expenditures or actual receipts; and that the grant activity is in full compliance w ith Article IX, Sec. 14 of the New Mexico Constitution know n as the "anti donation" clause. Xxxxxxx Xxxxxx Officer Grantee Representative or Fiscal Agent (if applicable ) Printed Name Printed Name Date: Date: (State Agency Use Only) Vendor Code: Fund No.: Loc No.: I certify that the State Agency financial and vendor file information agree with the above submitted information. Division Fiscal Officer Date Division Project Manager Date NOTICE OF OBLIGATION TO REIMBURSE GRANTEE EXHIBIT 2 Notice of Obligation to Reimburse Grantee [# 1] DATE: [ ] TO: Department Representative: [ , FROM: Grantee: [ Grantee Official Representative: [ ] ] ] SUBJECT: Notice of Obligation to Reimburse Grantee Grant Number: [ ] Grant Termination Date: [ ] As the designated representative of the Department for Grant Agreement number [ ] entered into between Grantee and the Department, I certify that the Grantee has submitted to the Department the following third party obligation executed, in writing, by the third party’s authorized representative: Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] I certify that the State is issuing this Notice of Obligation to Reimburse Grantee for permissible purposes within the scope of the project description, subject to all the terms and conditions of the above referenced Grant Agreement. Grant Amount (Minus AIPP if applicable): [ ] The Amount of this Notice of Obligation: [ ] The Total Amount of all Previously Issued Notices of Obligation: [ ] The Total Amount of all Notices of Obligation to Date: [ ] Note: Contract amounts may exceed the total grant amount, but the invoices paid by the grant will not exceed the grant amount. Department Rep. Approver: [ ] Title: [ ] Signature: [ ] Date: [ ] (EDD/NMMS U Exhibit 3 GRANTEE MATCH DETAIL FORM To Be Completed by the Grantee and Submitted with Each Payment Request Form The Grantee is expected to provide $2.00 (two dollars) to match every $10.00 (ten dollars) awarded. Communities receiving funds for Great Blocks on MainStreet to develop construction-ready documents must provide a full 20% cash match. Grantees are expected to keep accurate and timely records documenting matching contributions. The Grantee Match Detail form must be included with each Request for Reimbursement.

Compliance Certification. Under penalty of law law, I hereby certify to the best of my know ledge knowledge and belief, the above inf ormation information is correct; expenditures are properly documented, and are valid expenditures or actual receipts; and that the grant activity is in full compliance w ith with Article IX, Sec. 14 of the New Mexico Constitution know n known as the "anti donation" clause. Xxxxxxx Xxxxxx Grantee Fiscal Officer Grantee Representative or Fiscal Agent (if applicable applicable) Printed Name Printed Name Date: Vendor Code: Printed Name Date: (State Agency Use Onlyonly) Vendor Code: Fund No.: Loc Xxx No.: I certify that the State the·State Agency financial and vendor file information agree with the above submitted information. Division Fiscal Officer Date Division Project Manager Date July 1, 2020- FY 2021 NOTICE OF OBLIGATION TO REIMBURSE GRANTEE EXHIBIT 2 Notice of Obligation to Reimburse Grantee [# 1] DATE: [ ] TO: Department Representative: [ , P_r_o_je_c_t_M_a_n_ag�e_r_·___ FROM: Grantee: [ Grantee Entity:----- ------------ ------- Grantee Official Representative: [ ] ] ] __ SUBJECT: Notice of Obligation to Reimburse Grantee Grant Number: [ ] - - Grant Termination Date: [ ] ___ As the designated representative of the Department for Grant Agreement number [ ] _ _ entered into between Grantee and the Department, I certify that the Grantee has submitted to the Department the following third party obligation executed, in writing, by the third party’s 's authorized representative: Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] I certify that the State is issuing this Notice of Obligation to Reimburse Grantee for permissible purposes within the scope of the project description, subject to all the terms and conditions of the above referenced Grant Agreement. Grant Amount (Minus AIPP if applicable): [ ] The Amount of this Notice of Obligation: [ ] The Total Amount of all Previously Issued Notices of Obligation: [ ] The Total Amount of all Notices of Obligation to Date: [ ] $ 0.00 Note: Contract amounts may a ounts JJJC!J exceed the total grant amounttotalgrant a ount, but the invoices paid by ry the grant will 1vi not exceed the grant amounta ount. Department Rep. Approver: [ ] Title: [ ] Project Manager Signature: [ ] Date: [ ] t Administrative and/or Indirect Cosr - generally, rhe legislation authorizing rhe issuance of bonds prohibits rhe use of irs proceeds for indirect expenses (EDD/NMMS U Exhibit 3 GRANTEE MATCH DETAIL FORM To Be Completed e.g. penalty fees or damages other than pay for work performed, attorney fees, and administrative fees). Such use of bond proceeds shall not be allowed unless specifically autl10rized by statute. XXXXXXXX XXXXX XXXXXXX GOVERNOR XXXXXX X.-OUINTANA DIRECTOR XXXXXXX X. XXXXXX ACTING CABINET SECRETARY October 22, 0000 Xxxx Xxxxxx STATE OF NEW MEXICO DEPARTMENT OF FINANCE AND ADMINISTRATION LOCAL GOVERNMENT DIVISION Bataan Memorial Building • 000 Xxxxxxxx Xx. • Suite 202 • Xxxxx Xx, XX 00000 PHONE (000) 000-0000 ♦ FAX (000) 000-0000 Mayor, City of Santa Fe 000 Xxxxxxx Xxx Xxxxx Xx, XX 00000 Re: Special Conditions for City of Santa Fe Capital Outlay Projects, per E.O. 13-006 Dear Mayor Xxxxxx: Our many thanks to you and the Grantee other City of Santa Fe representatives for a very productive meeting on Monday, October 19th , concerning ce1tification of the City of Santa Fe for purposes of the Executive Order 2013-006 and Submitted New Mexico Capital Outlay projects. As discussed, in accordance with Each Payment Request Form The Grantee is expected to provide $2.00 (two dollars) to match every $10.00 (ten dollars) awarded. Communities receiving funds for Great Blocks on MainStreet to develop construction-ready documents must provide a full 20% cash match. Grantees are expected to keep accurate and timely records documenting matching contributions. The Grantee Match Detail form E.O. 2013- 006, the following uniform funding criteria must be included with each Request met for Reimbursement.a Local Government grantee to be eligible to receive a grant of a State Capital Outlay appropriation:

Compliance Certification. Under penalty of law law, I hereby certify to the best of my know ledge knowledge and belief, the above inf ormation information is correct; expenditures are properly documented, and are valid expenditures or actual receipts; and that the grant activity is Is in full compliance w ith with Article IX, Sec. 14 of the New Mexico Constitution know n known as the "''anti donation" clause. Xxxxxxx Xxxxxx Grantee Fiscal Officer Grantee Representative or Fiscal Agent (if applicable applicable) Printed Name tfame Printed Name tfame Date: Date: ({State Agency Use Only) Vendor Code: Fund No.: Loc Xxx No.: I certify that the State Agency financial and vendor file information agree with the above submitted information. Division Fiscal Officer Date Division Project Manager Date . . f NOTICE OF OBLIGATION TO REIMBURSE GRANTEE EXHIBIT 2 Notice of Obligation to Reimburse Grantee [Grantee# 1] DATE: [ ] TO: Department Representative: [ _ , FROM: Grantee: [ Grantee Entity:---------- - Grantee Official Representative: [ ] ] ] :_________ _ SUBJECT: Notice otice of Obligation to Reimburse Grantee Grant Number: [ ] Number:- ---- Grant Termination Terrnination Date: [ ] _ _ As the designated representative of the Department for Grant Agreement number [ ] _ entered into between Grantee and the Department, I certify that the Grantee has submitted to the Department the following third party obligation executed, in writing, by the third party’s 's authorized representative: Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] I certify that the State is issuing this Notice of Obligation to Reimburse Grantee for permissible purposes within the scope of the project descriptiondescciption, subject to all the terms and conditions of the above referenced Grant Agreement. Grant Amount (Minus AIPP if applicable): [ ] The Amount of this Notice of Obligation: [ ] The Total Amount of all Previously Issued Notices of Obligation: [ ] The Total Amount Amow1t of all Notices of Obligation to Date: [ ] $ 0.00 Note: Contract amounts may amo1111ts mqy exceed the total grant totalgrant amount, but the invoices paid by invoicespaid ry the grant will gra11t 1vill not exceed the grant amount. 0 101111/. Department Rep. Approver: [ ] Title: [ ] Signature: [ ] Date: [ ] I Administrative and/ or Indirect Cost - generally, the legislation authorizing the issuance of bonds prohibits the use of its proceeds for indirect expenses (EDD/NMMS U e.g. penalty fees or damages other than pay for work performed, attomcy fees, and administrative fees). Such use of bond proceeds shall not be allowed unless specifically authorized by statute. STATE OF Nt:W MEXICO CAPITAL GRANT PROJECT Request for Payment Form Exhibit 3 GRANTEE MATCH DETAIL FORM To Be Completed by the 1 I. Grantee and Submitted with Each Information II. Payment Computation (Make sure information is complete & accurate) A. Payment Request Form The Grantee is expected to provide No. A. Grantee: X. Xxxxx Amount: $2.00 0.00 B. Address: C. AIPP Amount (two dollarsIf Applicable): $0.00 (Complete Mailing, including Suite, if applicable) to match every $10.00 (ten dollars) awarded. Communities receiving funds for Great Blocks on MainStreet to develop construction-ready documents must provide a full 20% cash match. Grantees are expected to keep accurate and timely records documenting matching contributions. The Grantee Match Detail form must be included with each Request for Reimbursement.City, State, Zip

Compliance Certification. Under penalty of law law, I hereby certify to the best of my know ledge knowledge and belief, the above inf ormation information is correct; expenditures are properly documented, and are valid expenditures or actual receipts; and that the grant activity is Is in full compliance w ith with Article IX, Sec. 14 of the New Mexico Constitution know n known as the "''anti donation" clause. Xxxxxxx Xxxxxx Officer Grantee Representative or Fiscal Agent (if applicable applicable) Printed Name Printed Name Date: Date: ({State Agency Use Only) Vendor Code: Fund No.: Loc Xxx No.: I certify that the State Agency financial and vendor file information agree with the above submitted information. Division Fiscal Officer Date Division Project Manager Date . . f NOTICE OF OBLIGATION TO REIMBURSE GRANTEE EXHIBIT 2 Notice of Obligation to Reimburse Grantee [Grantee# 1] DATE: [ ] TO: Department Representative: [ _ , FROM: Grantee: [ Grantee Entity:---------- - Grantee Official Representative: [ ] ] ] :_________ _ SUBJECT: Notice of Obligation to Reimburse Grantee Grant Number: [ ] Number:- ---- Grant Termination Terrnination Date: [ ] _ _ As the designated representative of the Department for Grant Agreement number [ ] _ entered into between Grantee and the Department, I certify that the Grantee has submitted to the Department the following third party obligation executed, in writing, by the third party’s 's authorized representative: Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] I certify that the State is issuing this Notice of Obligation to Reimburse Grantee for permissible purposes within the scope of the project descriptiondescciption, subject to all the terms and conditions of the above referenced Grant Agreement. Grant Amount (Minus AIPP if applicable): [ ] The Amount of this Notice of Obligation: [ ] The Total Amount of all Previously Issued Notices of Obligation: [ ] The Total Amount Amow1t of all Notices of Obligation to Date: [ ] $ 0.00 Note: Contract amounts may amo1111ts mqy exceed the total grant totalgrant amount, but the invoices paid by invoicespaid ry the grant will gra11t 1vill not exceed the grant amount. 011101111/. Department Rep. Approver: [ ] Title: [ ] Signature: [ ] Date: [ ] I Administrative and/ or Indirect Cost - generally, the legislation authorizing the issuance of bonds prohibits the use of its proceeds for indirect expenses (EDD/NMMS U e.g. penalty fees or damages other than pay for work performed, attomcy fees, and administrative fees). Such use of bond proceeds shall not be allowed unless specifically authorized by statute. STATE OF Nt:W MEXICO CAPITAL GRANT PROJECT Request for Payment Form Exhibit 3 GRANTEE MATCH DETAIL FORM To Be Completed by the 1 I. Grantee and Submitted with Each Information II. Payment Computation (Make sure information is complete & accurate) A. Payment Request Form The Grantee is expected to provide No. X. Xxxxxxx: X. Xxxxx Xxxxxx: $2.00 0.00 B. Address: C. AIPP Amount (two dollarsIf Applicable): $0.00 (Complete Mailing, including Suite, if applicable) to match every $10.00 (ten dollars) awarded. Communities receiving funds for Great Blocks on MainStreet to develop construction-ready documents must provide a full 20% cash match. Grantees are expected to keep accurate and timely records documenting matching contributions. The Grantee Match Detail form must be included with each Request for Reimbursement.City, State, Zip

Compliance Certification. Under penalty of law law, I hereby certify to the best of my know ledge knowledge and belief, the above inf ormation information is correct; expenditures are properly documented, and are valid expenditures or actual receipts; and that the grant activity is in full compliance w ith with Article IX, Sec. 14 of the New Mexico Constitution know n known as the "anti donation" clause. Xxxxxxx Xxxxxx Officer Grantee Representative or Fiscal Agent (if applicable applicable) Printed Name Printed Name Date: Vendor Code: Printed Name Date: (State Agency Use Onlyonly) Vendor Code: Fund No.: Loc Xxx No.: I certify that the State the·State Agency financial and vendor file information agree with the above submitted information. Division Fiscal Officer Date Division Project Manager Date July 1, 2020- FY 2021 NOTICE OF OBLIGATION TO REIMBURSE GRANTEE EXHIBIT 2 Notice of Obligation to Reimburse Grantee [# 1] DATE: [ ] TO: Department Representative: [ , P_r_o_je_c_t_M_a_n_ag�e_r_·___ FROM: Grantee: [ Grantee Entity:----- ------------ ------- Grantee Official Representative: [ ] ] ] __ SUBJECT: Notice of Obligation to Reimburse Grantee Grant Number: [ ] - - Grant Termination Date: [ ] ___ As the designated representative of the Department for Grant Agreement number [ ] _ _ entered into between Grantee and the Department, I certify that the Grantee has submitted to the Department the following third party obligation executed, in writing, by the third party’s 's authorized representative: Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] I certify that the State is issuing this Notice of Obligation to Reimburse Grantee for permissible purposes within the scope of the project description, subject to all the terms and conditions of the above referenced Grant Agreement. Grant Amount (Minus AIPP if applicable): [ ] The Amount of this Notice of Obligation: [ ] The Total Amount of all Previously Issued Notices of Obligation: [ ] The Total Amount of all Notices of Obligation to Date: [ ] $ 0.00 Note: Contract amounts may JJJC!J exceed the total grant totalgrant amount, but the invoices paid by ry the grant will 1vill not exceed the grant amount. Department Rep. Approver: [ ] Title: [ ] Project Manager Signature: [ ] Date: [ ] t Administrative and/or Indirect Cosr - generally, rhe legislation authorizing rhe issuance of bonds prohibits rhe use of irs proceeds for indirect expenses (EDD/NMMS U Exhibit 3 GRANTEE MATCH DETAIL FORM To Be Completed e.g. penalty fees or damages other than pay for work performed, attorney fees, and administrative fees). Such use of bond proceeds shall not be allowed unless specifically autl10rized by statute. XXXXXXXX XXXXX XXXXXXX GOVERNOR XXXXXX X.-XXXXXXXX DIRECTOR XXXXXXX X. XXXXXX ACTING CABINET SECRETARY October 22, 0000 Xxxx Xxxxxx STATE OF NEW MEXICO DEPARTMENT OF FINANCE AND ADMINISTRATION LOCAL GOVERNMENT DIVISION Bataan Memorial Building • 000 Xxxxxxxx Xx. • Suite 202 • Xxxxx Xx, XX 00000 PHONE (000) 000-0000 ♦ FAX (000) 000-0000 Mayor, City of Santa Fe 000 Xxxxxxx Xxx Xxxxx Xx, XX 00000 Re: Special Conditions for City of Santa Fe Capital Outlay Projects, per E.O. 13-006 Dear Mayor Xxxxxx: Our many thanks to you and the Grantee other City of Santa Fe representatives for a very productive meeting on Monday, October 19th , concerning ce1tification of the City of Santa Fe for purposes of the Executive Order 2013-006 and Submitted New Mexico Capital Outlay projects. As discussed, in accordance with Each Payment Request Form The Grantee is expected to provide $2.00 (two dollars) to match every $10.00 (ten dollars) awarded. Communities receiving funds for Great Blocks on MainStreet to develop construction-ready documents must provide a full 20% cash match. Grantees are expected to keep accurate and timely records documenting matching contributions. The Grantee Match Detail form E.O. 2013- 006, the following uniform funding criteria must be included with each Request met for Reimbursement.a Local Government grantee to be eligible to receive a grant of a State Capital Outlay appropriation:

Compliance Certification. Under penalty of law law, I hereby certify to the best of my know ledge knowledge and belief, the above inf ormation information is correct; expenditures are properly documented, and are valid expenditures or actual receipts; and that the grant activity is in full compliance w ith with Article IX, Sec. 14 of the New Mexico Constitution know n known as the "anti donation" clause. Xxxxxxx Xxxxxx Officer Grantee Representative or Fiscal Agent (if applicable ) Printed Name Printed Name Date: Date: (State Agency Use Only) Vendor Code: Fund No.: Loc No.: I certify that the State Agency financial and vendor file information agree with the above submitted information. Division Fiscal Officer Date Division Project Manager Date September 2014 NOTICE OF OBLIGATION TO REIMBURSE GRANTEE EXHIBIT 2 Notice of Obligation to Reimburse Grantee [# 1] _ DATE: [ ] TO: Department Representative: [ , FROM: GranteeGrantee Entity: [ Grantee Official Representative: [ ] ] ] SUBJECT: Notice of Obligation to Reimburse Grantee Grant Number: [ ] Grant Termination Date: [ ] As the designated representative of the Department for Grant Agreement number [ ] entered into between Grantee and the Department, I certify that the Grantee has submitted to the Department the following third party obligation executed, in writing, by the third party’s authorized representative: Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] I certify that the State is issuing this Notice of Obligation to Reimburse Grantee for permissible purposes within the scope of the project description, subject to all the terms and conditions of the above referenced Grant Agreement. Grant Amount (Minus AIPP if applicable): [ ] The Amount of this Notice of Obligation: [ ] The Total Amount of all Previously Issued Notices of Obligation: [ ] The Total Amount of all Notices of Obligation to Date: [ ] Note: Contract amounts may exceed the total grant amount, but the invoices paid by the grant will not exceed the grant amount. Department Rep. Approver: [ ] Title: [ ] Signature: [ ] Date: [ ] 1 Administrative and/or Indirect Cost – generally, the legislation authorizing the issuance of bonds prohibits the use of its proceeds for indirect expenses (EDD/NMMS U Exhibit 3 GRANTEE MATCH DETAIL FORM To Be Completed e.g. penalty fees or damages other than pay for work performed, attorney fees, and administrative fees). Such use of bond proceeds shall not be allowed unless specifically authorized by the Grantee and Submitted with Each Payment Request Form The Grantee is expected to provide $2.00 (two dollars) to match every $10.00 (ten dollars) awarded. Communities receiving funds for Great Blocks on MainStreet to develop construction-ready documents must provide a full 20% cash match. Grantees are expected to keep accurate and timely records documenting matching contributions. The Grantee Match Detail form must be included with each Request for Reimbursementstatute.

Compliance Certification. Under penalty of law law, I hereby certify to the best of my know ledge knowledge and belief, the above inf ormation information is correct; expenditures are properly documented, and are valid expenditures or actual receipts; and that the grant activity is in full compliance w ith with Article IX, Sec. 14 of the New Mexico Constitution know n known as the "anti donation" clause. Xxxxxxx Xxxxxx Grantee Fiscal Officer Grantee Representative or Fiscal Agent (if applicable ) Applicable): Grantee Representative: Printed Name Name: Printed Name Name: Date: Date: (State Agency Use Only) Vendor Code: Code Fund No.: Loc No.: Code 89200 I certify that the State Agency financial and vendor file information agree with the above submitted information. Division (SAP PA) Fiscal Officer Date Officer/ Date: Division (CPB) Project Manager Date Manager/Date: SAMPLE NOTICE OF OBLIGATION TO REIMBURSE GRANTEE EXHIBIT 2 2‌ Notice of Obligation to Reimburse Grantee [# 1] DATE: [ ] TO: Department Representative: [ , _Xxxxxx Xxxxx FROM: Grantee: [ Town of Taos Grantee Official Representative: [ ] ] ] SUBJECT: Notice of Obligation to Reimburse Grantee Grant Number: [ ] Grant SAP 19-D2556-XX Xxxxx Termination Date: [ ] June 30, 2023 As the designated representative of the Department for Grant Agreement number [ ] SAP 19-D2556-GF entered into between Grantee and the Department, I certify that the Grantee has submitted to the Department the following third party Third-Party obligation executed, in writing, by the third partyThird-Party’s authorized representative: Vendor or Contractor: [ ] Third Third-Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Third-Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Third-Party Obligation Amount: [ ] I certify that the State is issuing this Notice of Obligation to Reimburse Grantee for permissible purposes within the scope of the project description, subject to all the terms and conditions of the above referenced Grant Agreement. Grant Amount (Minus AIPP if applicable): [ ] The Amount of this Notice of Obligation: [ ] The Total Amount of all Previously Issued Notices of Obligation: [ ] The Total Amount of all Notices of Obligation to Date: [ ] Note: Contract amounts may exceed the total grant amount, but the invoices paid by the grant will not exceed the grant amount. Department Rep. Approver: [ ] Title: [ ] Signature: [ ] Date: [ ] 1 Administrative and/or Indirect Cost – generally, the legislation authorizing the issuance of bonds prohibits the use of its proceeds for indirect expenses (EDDe.g. penalty fees or damages other than pay for work performed, attorney fees, and administrative fees). Such use of bond proceeds shall not be allowed unless specifically authorized by statute. NMED ATTACHMENT A NEW MEXICO ENVIRONMENT DEPARTMENT CONSTRUCTION PROGRAMS BUREAU PROJECT DESCRIPTION Name of Grantee: Town of Taos Project Number: SAP 19-D2556-GF X X Official Representative/NMMS U Exhibit 3 GRANTEE MATCH DETAIL FORM To Be Completed Date NMED Project Manager Approval/Date REVIEW‌‌ NMED ATTACHMENT B – NMENV TECHNICAL REQUIREMENTS TO STATE OF NEW MEXICO CAPITAL APPROPRIATION FUND AGREEMENT Upon execution of the agreement, the Grantee will follow the procedures listed below unless waived in writing by the Grantee and Submitted with Each Payment Request Form The Grantee is expected to provide $2.00 New Mexico Environment Department (two dollarsNMED) to match every $10.00 (ten dollars) awarded. Communities receiving funds for Great Blocks on MainStreet to develop construction-ready documents must provide a full 20% cash match. Grantees payment may be withheld if any of these procedures are expected to keep accurate and timely records documenting matching contributions. The Grantee Match Detail form must be included with each Request for Reimbursementnot followed by the Grantee).

Compliance Certification. Under penalty of law , I hereby certify to the best of my know ledge and belief, the above inf ormation is correct; expenditures are properly documented, and are valid expenditures or actual receipts; and that the grant activity is in full compliance w ith Article IX, Sec. 14 of the New Mexico Constitution know n as the "anti donation" clause. Xxxxxxx Xxxxxx Officer Grantee Representative or Fiscal Agent (if applicable ) Printed Name Printed Name Date: Date: (State Agency Use Only) Vendor Code: Fund No.: Loc No.: I certify that the State Agency financial and vendor file information agree with the above submitted information. Division Fiscal Officer Date Division Project Manager Date NOTICE OF OBLIGATION TO REIMBURSE GRANTEE EXHIBIT 2 Notice of Obligation to Reimburse Grantee [# 1] DATE: [ ] TO: Department Representative: [ , FROM: Grantee: [ Grantee Official Representative: [ ] ] ] SUBJECT: Notice of Obligation to Reimburse Grantee Grant Number: [ ] Grant Termination Date: [ ] As the designated representative of the Department for Grant Agreement number [ ] entered into between Grantee and the Department, I certify that the Grantee has submitted to the Department the following third party obligation executed, in writing, by the third party’s authorized representative: Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] Vendor or Contractor: [ ] Third Party Obligation Amount: [ ] I certify that the State is issuing this Notice of Obligation to Reimburse Grantee for permissible purposes within the scope of the project description, subject to all the terms and conditions of the above referenced Grant Agreement. Grant Amount (Minus AIPP if applicable): [ ] The Amount of this Notice of Obligation: [ ] The Total Amount of all Previously Issued Notices of Obligation: [ ] The Total Amount of all Notices of Obligation to Date: [ ] Note: Contract amounts may exceed the total grant amount, but the invoices paid by the grant will not exceed the grant amount. Department Rep. Approver: [ ] Title: [ ] Signature: [ ] Date: [ ] (EDD/NMMS U Exhibit EXHIBIT 3 GRANTEE MATCH DETAIL FORM To Be Completed to be completed by the Grantee and Submitted submitted with Each each Payment Request Form The Grantee is expected required to provide a matching contribution valued at two dollars ($2.00 2.00) in match for every ten dollars (two dollars$10.00) to of the total Grant Amount. At least sixty percent (60%) of the Grantee’s match every $10.00 (ten dollars) awardedmust be in the form of cash, and the remainder may be in the form of in-kind contributions by the Grantee. Communities receiving funds for Great Blocks on MainStreet to develop construction-ready documents must provide a full 20% cash match. Grantees are expected to keep accurate and timely records documenting matching contributions. The Grantee Match Detail form must be included with each Request for Reimbursement. An in-kind contribution is any service or item of cost that is necessary for the completion of the work and that has a verifiable and accountable economic value. Some examples of in-kind contributions include: • MainStreet Executive Director’s time dedicated to coordinating project activities; • Value of the time and cost associated with assigning municipal staff to project activities; • Items of cost borne by the municipality or one of the municipality’s partners in the project; • Cost of publicizing notices of meetings and events.