AHC Form D-3 Disbursements Certification Home Improvement Project

Form AHC D-3

(On Letterhead of Grantee)

Subsequent Disbursements Certification For Home Improvement Projects

In accordance with the provisions of the Grant Agreement dated , for I , , (AHC# and Project Name) (Name) (Title) of the , hereby certify as follows: (Grantee)

(all terms used herein will have the same meaning as defined in the Grant Agreement):

(a) That $______has been disbursed by the Corporation to the Grantee;

(b) That at least 75% (or $______) of the amount set forth in (a) above has been expend or committed pursuant to Home Improvement Contracts and Plans, where such Plans are required by law; and

(c)* That the Grantee has received for each unit improved or to be improved, evidence of site control and a Home Improvement Contract and Plans, if such Plans are required by law. (or)

(c)* That the Grantee has received evidence from a Participating Party (Parties) that the Participating Party (Parties) has received, for each unit improved or to be improved, evidence of site control and a Home Improvement Contract and Plans, if such Plans are required by law.

Signature

* Please select the alternatives (c) certification that applies to Grantee’s project.