Checklist for Site Certificate 05-16

OMB Number: 0610-0096
Expiration Date: 11/30/2021

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ECONOMIC DEVELOPMENT ADMINISTRATION
SITE CERTIFICATE CHECKLIST
EDA Award Number:

Date:

Recipient:
Co-Recipient(s):
Recipient’s Authorized Representative:
Name & Phone Number
Executed or
Draft Site Certificate titled “Certificate as to Project Site, Rights-of-Way,
and Easements” has demonstrated that the Recipient has acquired good and marketable title to land,
free of all encumbrances, and rights-of-way and easements necessary fort the completion of the
project, or of a long-term leasehold interest in accordance with 13 CFR 314.
The Site Certificate document satisfies Special Award Condition Number(s):

.
Y

1. All Special Award Conditions required for the Evidence of good Title have
been met.
2. All three parts of the Site Certificate form have been completely filled out
and it has been submitted to EDA for review.
3. Part I – Certificate of Architect/Engineer has been completed and signed by the
Project’s Architect/Engineer.
4. Part I – Certificate of Architect/Engineer includes property descriptions, exhibits
and maps that clearly depict all the property that is required for the project, and
show the project components relative to the property.
5. Part II – Title Opinion has been completed and signed by the Owner’s Attorney
and has been completed after Part I has been filled out.
6. Part III - Owner’s Certification Regarding Eminent Domain has been completed
and signed by the authorized representative of the Recipient.

Prepared By (Signature)

Date

Prepared By (Typed or Written Name & Title)

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N

NA