PROJECT BUDGET: Total of Components cannot exceed the maximum total award amount GRANTEE CERTIFICATION I am the representative of the provider (“Grantee”) listed above who is authorized to execute this form. The above named project /grant award is in accordance with Section 13 of Public Act 15-1, the Notice of Grant Award, General Grant Conditions and NGP Grant Conditions. The Grantee has authorized the project for which it will receive State of Connecticut funds. The information contained on this form is true, accurate and complete. By (signature of authorized representative): ________________________________________________ Printed Name: Dennis Perry Title: Executive Director Signed at , Connecticut, this day of 20 . (town/city/or borough) FOR OPM USE: Grant Administrator Name: Valerie Clark Grant Administrator Phone: 860-418-6313 Grant Administrator Email: Valerie.clark@ct.gov
PROJECT BUDGET: Total of Components cannot exceed the maximum total award amount GRANTEE CERTIFICATION I am the representative of the provider (“Grantee”) listed above who is authorized to execute this form. The above named project /grant award is in accordance with Section 13 of Public Act 15-1, the Notice of Grant Award, General Grant Conditions and NGP Grant Conditions. The Grantee has authorized the project for which it will receive State of Connecticut funds. The information contained on this form is true, accurate and complete. By (signature of authorized representative): ________________________________________________ Printed Name: Dennis Perry Title: Executive Director Signed at , Connecticut, this day of 20 . (town/city/or borough) FOR OPM USE: Grant Administrator Name: Valerie Clark Grant Administrator Phone: 860-418-6313 Grant Administrator Email: Valerie.clark@ct.gov
Abilis_Round_5.docx