3-Certification Letter.docx
DOCX document 14 KB Posted
- Solicitation number
- ALTSD CO - Planning & Design - Draft - Similar 2
- Issued by
- New Mexico
About this file
This is a Certification Letter form associated with the New Mexico Aging and Long Term Services Department's Capital Outlay 2028 Application for Planning & Design funding directed toward senior center facilities. The form serves as a fiscal agent certification document wherein the responsible party acknowledges the reimbursement-based nature of the capital outlay appropriation and confirms willingness and financial capacity to administer the project. The fiscal agent must comply with applicable procurement, fiscal, reporting, and reimbursement requirements; pay allowable project costs in advance of reimbursement; submit complete reimbursement requests with supporting documentation; and assume full responsibility for the requested amount subject to the grant agreement and available appropriation authority.
The certification letter requires completion of key project information fields including the senior center facility name, application type, project title, amount requested, fiscal agent identification, advance-funding source, and authorized representative details including name, title, email, telephone, and signature with date. The form functions as a prerequisite commitment document for applicants seeking planning and design funding for pre-construction activities such as needs assessments, feasibility analyses, surveys, engineering, architectural services, design work, cost estimating, regulatory review, permitting support, specifications development, and construction document preparation for senior center capital projects in New Mexico.
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Other files
| File | Type | Posted |
|---|---|---|
| 2-Scope of Work and Deliverables Schedule Worksheet.docx | DOCX document | |
| 1-Project Budget and Funding Sources Worksheet.docx | DOCX document |
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Text version
Certification Letter The undersigned fiscal agent acknowledges that the requested Capital Outlay appropriation is reimbursement-based. The fiscal agent confirms that it is willing and financially able to administer the project, comply with applicable procurement, fiscal, reporting, and reimbursement requirements, pay allowable project costs before reimbursement is received, submit complete reimbursement requests and supporting documentation, and assume responsibility for the full amount requested, subject to the grant agreement and available appropriation authority.
Senior Center Facility: _________________________________________________ Application Type: _____________________________________________________ Project Title: _________________________________________________________ Amount Requested: $ _________________________________________________ Fiscal Agent: ________________________________________________________ Advance-Funding Source: ______________________________________________ Authorized Representative Name: ________________________________________ Title: _______________________________________________________ Email: ______________________________________________________________ Telephone: __________________________________________________________ Signature: ___________________________________________________________ Date: _______________________________________________________________
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