Guam Hazard Mitigation Plan - Western States Seismic Policy Council

Appendix GPlan Maintenance DocumentsHAZARD MITIGATION GRANT PROGRAMFINAL CLAIMUpon completion of all work and payment of expenditures, please submit this sheet withyour final Request for Reimbursement to:Raymond F.Y. Blas, Governor’s Authorized RepresentativeRecovery Coordination Office542 A. North Marine DriveTamuning, GU 96932APPLICANT NAME:_________________________________________________________________PHONE NUMBER:___________________________________________________________HAZARD MITIGATION PROJECT #:_________________________________________FEDERAL DISASTER #:______________________________________________________SUBGRANTEE CERTIFICATION:I HEREBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALLWORK AND COSTS CLAIMED ARE ELIGIBLE IN ACCORDANCE WITH THE GRANTCONDITIONS; ALL WORK CLAIMED HAS BEEN COMPLETED; AND ALL COSTSCLAIMED HAVE BEEN PAID IN FULL.SIGNED: ________________________________ DATE: __________________Authorized Applicant’s AgentTITLE OF AUTHORIZED AGENT: _____________________________G-4