Form 13-B Certificate of Completion Form

Form 13-B  Certificate of Completion Form

Certificate of Completion

Grantee: Grant Number:

Grant Amount:

1. Amount of grant funds expended per Final Progress Report:

2. Amount of grant funds returned to MEDC:

3. Amount of grant funds expended subsequent to submission of Final Progress Report:

4. Amount of Local Match funds expended for Total Project:

5. Amount of Private Match funds expended for Total Project:

List activities undertaken with Grant, Local and/or Private Funds:

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Certification of Grant Authorized Local Official

I hereby certify that all activities undertaken by the Grantee with funds provided under the grant agreement identified above have, to the best of my knowledge, been carried out in accordance with all provisions of the grant agreement; that proper provision has been made by the Grantee for payment of all unpaid costs and any unsettled third-party claims; that the State of Michigan is under no obligations to make any further payments to the Grantee under this grant agreement; and that every statement and amount set forth in this certificate is, to the best of my knowledge, true and correct as of this date.

Date: ______

______Name and Title of Authorized Local Official

______Signature of Authorized Local Official

13B-1 Michigan Economic Development Corporation Released September 2013