ࡱ> .0- bjbjVV 4<<'..qqqqq8a-|qqq444Xqq4444"x j410a4KLK4Kq44^aK. 7: CONTRACTORS CLAIM CERTIFICATION Pursuant to Code of Virginia, I hereby certify that the contractual claim submitted in writing by ________________________ (name of Contractor) to (name of public body) arising from the Project (Project name) in ____________________County, Virginia, including any and all statements and records submitted in support of such claim, is a true and accurate representation of the claim, additional costs and/or delays the Contractor incurred in the performance of the required contract work. I further certify that the claim is not the result of, or affected by, any act of collusion with another person engaged in the same line of business or commerce; or any act of fraud punishable under the Virginia Governmental Frauds Act, 18.2-498.1, et seq. of the Code of Virginia. I understand that any statements made, and known to be false, shall be a violation of the Virginia Governmental Frauds Act, punishable as a Class 6 Felony. In addition, I understand that any claim submitted in violation of the Virginia Fraud Against Taxpayers Act, 8.01-216.1, et seq. of the Code of Virginia shall be subject to the civil penalties provided therein. (Contractor) By: As officer or duly appointed agent of (Contractor) Title: Date: State Of: City/County of __________________, To-Wit: I, the undersigned, a Notary Public in and for the City/ County and State aforesaid, do hereby certify that , whose name is signed to the foregoing instrument, bearing date of the _______ day of _______________, 20____ , has this day acknowledged the same before me in my City/ County and State aforesaid. Given under my hand this ______ day of ________, 20___ . Notary Public: My commission expires: Claims submitted without this Certification above shall not constitute a proper claim and, if not submitted with the Certification within the time required, shall be deemed to be waived.     DGS-30-234 (Rev. 10/10)  !"#/?W[fwT w 1   ּ̧̲֜֎ֲvֲ̧k]h{.h{.>*CJ^JaJh{.h{.CJaJh{.hCJ^JaJh>*CJ^JaJh{.h{.6CJ^JaJh{.>*CJ^JaJh{.6CJ^JaJhCJ^JaJh{.h{.6CJ]^JaJh{.CJ^JaJh{.h{.CJ^JaJh{.h{.5>*CJ^JaJh{.5>*CJ^JaJ$!"#   : lmd7$8$H$^`gd{. 7$8$H$gd{. d7$8$H$gd{.$7$8$H$`a$gd{. $7$8$H$a$gd{. $7$8$H$a$gd{.   J L M Q /C؇wld`d`d`d`hBjhBUhh-CJaJhCJaJh{.CJaJh{.h{.CJaJ!h{.h{.6>*CJ]^JaJh{.h{.6CJ]^JaJh{.6CJ]^JaJh{.6>*CJ]^JaJh{.CJ^JaJh{.h{.CJ^JaJh{.h{.>*CJ^JaJhh{.CJ^JaJ$]gdA 7$8$H$gdhh-CJaJhBh^;KhA hu5 hA521h:pr6k/ =!"#$% ^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH <`< {.Normal_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List HH {. Balloon TextCJOJQJ^JaJ4@4 AHeader  !4 4 AFooter  !PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]   &&&&&)   8@0(  B S  ?%,333)(y j~ & A#aD)%,{.46b=d@^;K<_NOO~X^`cir6kZr%rJptzQxa|t4,Vlu!n&>j5B-Zk@P@UnknownG* Times New Roman5Symbol3. * ArialGTimesNewRomanPSUTimesNewRomanPS-Italic5. *aTahomaACambria Math"1hffi i #24d3QHX ?{.2!xx CONTRACTOR S CLAIM CERTIFICATIONrhwjdpateOh+'0 $ D P \hpx$CONTRACTORS CLAIM CERTIFICATIONrhw Normal.dotmjdpate2Microsoft Office Word@@\"x@\"xi՜.+,0 hp|  oag  !CONTRACTORS CLAIM CERTIFICATION Title  !"#$&'()*+,/Root Entry F-x11TableKWordDocument4SummaryInformation(DocumentSummaryInformation8%CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q