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Va Form 10-0388-5 - Additional Documents And Information Required For State Home Construction And Acquisition Grants Application Page 4

SECTION VI - REQUIREMENTS DUE BY THE DATE ESTABLISHED IN VA'S COMMITMENT LETTER - Continued

Two copies of the itemized bid tabulations;

Completed VA form 10-0388-10, CERTIFICATION OF COMPLIANCE WITH FEDERAL REQUIREMENTS STATE HOME

CONSTRUCTION GRANT;

Revised SF 424, SF 424c budget pages, based on the selected bids (including final cost for all items in the project).

Three signed originals of the Memorandum of Agreement that includes provisions in the Sample Memorandum of Agreement

VA Form 10-0388-11 as set forth in 38 CFR.160.

SECTION VII - REQUIREMENTS DUE PRIOR TO GRANT AWARD

Prior to grant award, the State Representative must submit VA Form 10-0388-12, CERTIFICATION REGARDING DEBARMENT,

SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS (TO BE SIGNED BY

THE CONTRACTORS.

CERTIFICATION - The law provides severe penalties for willful submission of false information

I certify that the information submitted to VA is true and correct to the best of my knowledge and ability.

TITLE OF AUTHORIZED STATE OFFICIAL

NAME OF AUTHORIZED STATE OFFICIAL

SIGNATURE

DATE (mm/dd/yyyy)

VA FORM

10-0388-5

PAGE 4 OF 4

MAR 2005

Va Form 10-0388-5 - Additional Documents And Information Required For State Home Construction And Acquisition Grants Application Page 4