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Page - 1 | METROPOLITAN COUNCIL <br />2017 Municipal I&I Grant Program Cost Verification and Jobs Reporting Form <br />Completion of this form and submission of attachments is the basis for entering into agreement with the <br />Metropolitan Council on the 2017 I&I Grant program. This form and its attachments verify that the community <br />has finished I&I reduction projects, with costs eligible for reimbursement under the 2017 I&I Grant program. <br />Please send the completed form and required attachments to (electronic submission preferred): <br />Mail:Matt Gsellmeier, MCES Grant Administrator 390 N. Robert Street St. Paul, MN 55101 <br />Email:Matthew.Gsellmeier@metc.state.mn.us <br />Phone:(651) 602-1802 <br />Required Attachments: <br />Please attach and return the following items to Met Council by November 1, 2019: <br />1. The Cost Verification & Jobs Reporting Form (This form) <br />2. One of the following that applies to your city’s property situation: <br />o Attachment 1 to Grant Agreement – DECLARATION of Real Property, and <br />ƒAttachment II to Grant Agreement – Legal Description of Real Property, OR <br />o Attachment 1-A – CERTIFICATION pursuant to Waiver of Real Property Declaration for projects <br />located under any right of way, and <br />ƒExhibit A – LEGAL DESCRIPTION, NARRATIVE DESCRIPTION, OR MAP OF <br />RESTRICTED PROPERTY <br />3. A city resolution authorizing application and execution of the Grant agreement <br />4. A detailed breakdown of actual expenditures that tie-out to the project costs cited in the Cost <br />Verification Form. <br />o MCES may request additional documentation to verify expenditures. <br />5. Description of work completed <br />6. Invoices or other documents that substantiate the cost of work completed. <br />Required Cost Verification Information: <br />City:Lino Lakes, MN <br />City Official/Title:Diane Hankee / City Engineer <br />Phone #:651-982-2430 <br />Project Start Date:September 2018 <br />Project End Date:September 2019 <br />Were projects completed between May 31, 2017 and November 1, 2019 (Y/N):Y <br />In the space provided on the next page, please enter a summary of your costs, and your eligible I&I work. As a <br />reminder, the following work is considered non-eligible under the I&I program: <br />x Studies, investigations or inspections <br />x Any improvement to privately owned infrastructure