DT1865-1A Consultant Financial - Wisconsin Department of ...
CONSULTANT FINANCIAL REPORT (CFR) 1A
Wisconsin Department of Transportation
DT1865-1A 1/2013
PART 1A – Management Representation and Certification
|Firm Name |Fiscal Year Ended (m/d/yyyy) |
| | |
The above-named firm is providing this letter in connection with the Consultant Financial Report for the period specified above.
I, the undersigned, hereby certify that the following is true and accurate:
1. I am duly authorized to sign this Representation and Certification on behalf of the above-named firm, and that through my signature the firm is responsible for this Management Representation and Certification:
2. I have reviewed the information and documentation contained in the Consultant Financial Report, and any records necessary to confirm the accuracy of the information and documentation contained in the Report:
3. I attest that the information contained and submitted in this report is true, accurate and complete:
4. The Schedule of Indirect Costs and all related schedules were prepared in accordance with WisDOT agreement provisions, the Federal Acquisition Regulations (FAR) Part 31 (48 CFR 31), and WisDOT Facilities Development Manual Procedure 8-10-20;
5. All costs included in the establishment of the final indirect cost rate are allowable in accordance with the cost principles of FAR Part 31 (48 CFR 31);
6. The establishment of the final indirect cost rate did not include any costs which are expressly unallowable under the cost principles of FAR Part 31 (48 CFR 31);
7. All known material transactions or events that have occurred affecting the firm’s ownership, organization and indirect cost rates have been disclosed; and
8. I acknowledge that the information and Report is being submitted by the above-named firm for the express purpose of seeking and being eligible to be awarded contracts with the Wisconsin Department of Transportation, and that these contracts may include Federal funding,
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|(Print Name) | |(Area Code) Telephone Number |
| | | |
|(Title) | |(Email Address) |
|X | | |
|(Official Signature) | |(Date – m/d/yy) |
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