Annex 2C-4 (DRR_ not in hazard zone, no website)

MLGU Notarized Certification for Fund Release

FY 2020 LGSF-AM

LGU
LOGO

LETTERHEAD OF THE LOCAL GOVERNMENT UNIT

CERTIFICATION

In the implementation of (project title) amounting

to PhP_______________ in the Municipality of ____________________ under the FY 2020 Local
Government Support Fund-Assistance to Municipalities (LGSF-AM) Program, we hereby attest that:

1. Detailed Engineering Design (DED) has been prepared in accordance with Annex “A”
of 2016 Revised IRR of R.A. 9184 (Detailed Engineering for the Procurement of
Infrastructure Project), AM Project Menu, National Government standards, and relevant
provisions of the General Appropriations Act (GAA) and other applicable laws and
issuances, including but not limited to the following;

2. The Municipality has an established PIT, PMC, and Inspectorate Team based on the
attached Executive Orders issued by the undersigned.

3. Certified True Copies of the following documents are hereby attached:

3.1. Approved Detailed Engineering Design (DED);

3.2. Proof of application and/or payment of the following permits:

a. Environmental Compliance Certificate (ECC) or Certificate of Non-
Coverage (CNC) from the Department of Environment and Natural Resources–
Environmental Management Bureau (DENR-EMB), whichever is applicable.
b. Certificate of Non-Overlap (CNO) or Free, Prior and Informed Consent
(FPIC) from National Commission on the Indigenous People (NCIP), whichever
is applicable.
c. Other permits as may be required by-laws, rules, or other concerned agencies
for the implementation of the project.

3.3. Deed of Donation or Deed of Absolute Sale or Usufruct or any other legal
documents proving that the site of the project has no land ownership or Right-of-
Way (ROW) issues;

3.4. MGB Certification that the project is not located in the “no-build” zone and
hazard-prone area;

3.5. Executive Orders creating or activating the Municipality’s PIT, PMC and
Inspectorate Team.

4. The project is included in the updated and duly adopted Local Development Investment
Program (LDIP) of the Municipality and must not be funded from other sources.

5. The proposed AM Project is included in the approved Annual Procurement Plan of the
Municipality.

6. The bidding documents have been prepared and the bidding process can commence
within seven (7) calendar days upon receipt of fund. These documents will be made
available to DILG during field monitoring visits and/or as may be requested.
 Annex 2C-4 (DRR_ not in hazard zone, no website)
MLGU Notarized Certification for Fund Release
FY 2020 LGSF-AM

7. Disbursed funds downloaded to the Municipality from the national subsidy of DILG-OPDS
Administered Programs from previous funding years (2012-2018) have been fully
liquidated.

8. Undisbursed funds from the national subsidy of DILG-OPDS Administered Programs from
previous funding years (2012-2018) have been reverted to the source agency (DILG or
Bureau of Treasury) and the Notarized Affidavit of Undertaking, when applicable, were
submitted to the DILG, pursuant to applicable provisions of the General Appropriations Act
(GAA) and all the DILG Memoranda issued for the purpose;

9. Our Municipality commits and binds itself/ourselves to comply with all the provisions of the
Project Implementation and Monitoring Guidelines issued by the DILG.

10. Funds shall be made available for the maintenance once the project is completed.

11. The municipality commits to established a functional and operational website within the
year

We agree that our Municipality may be ineligible to receive a subsidy from the Assistance to
Municipalities (AM) Program in the next Fiscal Year (FY) if any of the above attestations/declarations
to be misrepresented or false.

We agree that our Municipality is primarily and solely accountable and responsible as to the
truthfulness of these attestations, and at the same time, further attests to the accuracy and
completeness of the submitted technical documents, as well as its consistencies and conformity to
national standards.

We further agree that our Municipality will be subjected to penalties and sanctions in case of non-
compliance to Project Implementation and Monitoring Guidelines issued by the DILG.

This Certification is being issued in compliance with the DILG Memorandum Circular No._____,
Series of 2020.

___(Signature over Printed Name)________ _______________

Municipal Planning and Development Coordinator Date

_____(Signature over Printed Name)______ ________________

Municipal Engineer Date

_____(Signature over Printed Name)______ ________________

Local Chief Executive Date

2
 Annex 2C-4 (DRR_ not in hazard zone, no website)
MLGU Notarized Certification for Fund Release
FY 2020 LGSF-AM

ACKNOWLEDGEMENT
REPUBLIC OF THE PHILIPPINES
(Municipality/City of ________________) S.S.

Subscribed and sworn to before me on this date, a Notary Public for and in __________, Philippines.

NOTARY PUBLIC

Doc. No. __________

Book No. __________
Page No. __________
Series of __________