Final payment certificate form (Atlantic Fisheries Fund)

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To be completed only if project finished

Recipient name: _________________________ Project number: _________________________

Final payment certificate

I hereby certify that:

1. the project was completed on (YYYY/MM/DD):

Yes

2. the project has been successfully completed in accordance with the statement of work.

3. the recipient has fully paid suppliers and employees for costs claimed.

4. all costs have been claimed at fair market value, net of any refunds, credits or other consideration provided by the supplier(s).

5. the project is free from any present or potential liens or claims that could jeopardize it.

6. all terms and conditions of the contribution agreement, including environmental mitigation measures, if any, have been met.

7. project assets are on site (have not been disposed of/sold, have not been leased to other parties or have not ceased to be used in the operation).

If you certified no to any of the above statements, please indicate the statement number and provide comments here:

For any project where the Atlantic Fisheries Fund Contribution was $100,000 or more, list all the funding sources and the amounts received for the project, including any funds received from other government departments, municipalities, Crown corporations or agencies.

I hereby solemnly declare that I have examined the Contribution Agreement for the above project and I certify that the above responses are true, knowing that this declaration is of the same force and effect as if made under oath and by virtue of the Canada Evidence Act.

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Final payment certificate form (Atlantic Fisheries Fund)

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To be completed only if project finished