"Final Invoice Certification Form" - Oklahoma

Final Invoice Certification Form is a legal document that was released by the Oklahoma Department of Transportation - a government authority operating within Oklahoma.

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Download "Final Invoice Certification Form" - Oklahoma

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FINAL INVOICE CERTIFICATION:
I certify that all services documented by this invoice and for which payment is claimed
were billed to the Department for hours actually expended by Consultant’s staff
members at the contractually specified rates for such staff members. I further certify
that overhead rate as charged to this Contract has been audited by a certified public
accounting firm, accepted by the Department, and has been properly applied to services
provided under this Contract. I further certify that all Sub-consultants, subcontractors
and others who provided labor, equipment or supplies have been fully paid
.
I understand that if the project which is subject of this Contract is financed in whole or in
part by federally furnished funds, that if I, the company that I represent, or any
employee or agent thereof, knowingly make any false statement, representation, report,
or claim as to the character, quality, quantity, or cost of material used or to be used, or
quantity or quality of work performed or to be performed, or make any false statement or
representation as a material fact in any statement, certificate, or report, I and the
company that I represent may be subject to prosecution under the provisions of 18
U.S.C. Section 1001 and 1020.
EC-________
Task Order Number_______
______________________
_____________________________
Signature
Printed Name
______________________
_____________________________
Position
Firm Name
Signed before me the undersigned notary this ____ day of __________, 20___,
(SEAL)
_____________________________
Notary Public
My Commission Expires: ____________
My Commission Number: _________
FINAL INVOICE CERTIFICATION:
I certify that all services documented by this invoice and for which payment is claimed
were billed to the Department for hours actually expended by Consultant’s staff
members at the contractually specified rates for such staff members. I further certify
that overhead rate as charged to this Contract has been audited by a certified public
accounting firm, accepted by the Department, and has been properly applied to services
provided under this Contract. I further certify that all Sub-consultants, subcontractors
and others who provided labor, equipment or supplies have been fully paid
.
I understand that if the project which is subject of this Contract is financed in whole or in
part by federally furnished funds, that if I, the company that I represent, or any
employee or agent thereof, knowingly make any false statement, representation, report,
or claim as to the character, quality, quantity, or cost of material used or to be used, or
quantity or quality of work performed or to be performed, or make any false statement or
representation as a material fact in any statement, certificate, or report, I and the
company that I represent may be subject to prosecution under the provisions of 18
U.S.C. Section 1001 and 1020.
EC-________
Task Order Number_______
______________________
_____________________________
Signature
Printed Name
______________________
_____________________________
Position
Firm Name
Signed before me the undersigned notary this ____ day of __________, 20___,
(SEAL)
_____________________________
Notary Public
My Commission Expires: ____________
My Commission Number: _________