Cost Verification and Certification for Highway Safety Project Applicant Agency: - - Highway Safety Project No.: PSP Task Number: Total Amount Reimbursed: $ I certify that the project reimbursed are supported in accordance with state and federal requirements. Verification has been made that costs and reimbursement claims are adequately supported by documentation and records as evidence of costs incurred, that costs claimed are allowable under NHTSA/FHWA requirements and reimbursement policies of the Division of Traffic Safety and qualify for federal reimbursement. Certification is based upon review made per the Cost Verification Checklist below. LEL/LAL/Grant Coordinator Date Final Cost Verification Check List 1. Nature of expenditures is compatible with project objectives and authorization. Yes 2. Project costs are controlled by approved line item project budget designating Yes allowable expenditures by cost category. 3. Any deviations from original project budget have been documented by properly Yes N/A approved budget revisions. 4. Expenditures for claimed are in accordance with the line item project Yes budget within the Highway Safety Project Agreement. 5. Adequate documentation of only those costs incurred within the approved Yes project period and budget have been submitted in support of costs claimed (particular attention should be directed to confirmation that costs of operation of automobiles has been documented by submittal of certified odometer logs). 6. Procurement transactions have been conducted in a manner that provides Yes N/A maximum open and free competition and in compliance with federal, state and division procurement requirements. 7. Proper inventory controls have been maintained over equipment purchased Yes N/A with safety funds in accordance with state, federal and division management standards. 8. A physical inventory of equipment purchased with safety grants was conducted Yes N/A on: 9. Consultant contracts have been administered in accordance with federal, state Yes N/A and division requirements. 10. The Division of Traffic Safety has conducted periodic on-site reviews to monitor Yes No N/A adherence to the project agreement and review project progress. 11. Agency has complied with Agreement Conditions of Highway Safety Project Yes Agreement. This completed form should be mailed to the Illinois Department of Transportation, Division of Traffic Safety, Attention: Law Enforcement Liaison Program, .
Cost Verification and Certification for Highway Safety Project Applicant Agency: Highway Safety Project No.: - - PSP Task Number: Total Amount Reimbursed: $ I certify that the project reimbursed are supported in accordance with state and federal requirements. Verification has been made that costs and reimbursement claims are adequately supported by documentation and records as evidence of costs incurred, that costs claimed are allowable under NHTSA/FHWA requirements and reimbursement policies of the Division of Traffic Safety and qualify for federal reimbursement. Certification is based upon review made per the Cost Verification Checklist below. LEL/LAL/Grant Coordinator Date Final Cost Verification Check List 1. Nature of expenditures is compatible with project objectives and authorization. Yes 2. Project costs are controlled by approved line item project budget designating allowable expenditures by cost category. Yes 3. Any deviations from original project budget have been documented by properly approved budget revisions. Yes N/A 4. Expenditures for claimed are in accordance with the line item project budget within the Highway Safety Project Agreement. Yes 5. Adequate documentation of only those costs incurred within the approved project period and budget have been submitted in support of costs claimed (particular attention should be directed to confirmation that costs of operation of automobiles has been documented by submittal of certified odometer logs). Yes 6. Procurement transactions have been conducted in a manner that provides maximum open and free competition and in compliance with federal, state and division procurement requirements. Yes N/A 7. Proper inventory controls have been maintained over equipment purchased with safety funds in accordance with state, federal and division management standards. Yes N/A 8. A physical inventory of equipment purchased with safety grants was conducted Yes N/A on: 9. Consultant contracts have been administered in accordance with federal, state and division requirements. Yes N/A 10. The Division of Traffic Safety has conducted periodic on-site reviews to monitor adherence to the project agreement and review project progress. Yes No N/A 11. Agency has complied with Agreement Conditions of Highway Safety Project Agreement. Yes This completed form should be mailed to the Illinois Department of Transportation, Division of Traffic Safety, Attention: Law Enforcement Liaison Program, .
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